To review advances in understanding the biology of cancer that will lead to new prognostic indicators and approaches for treating cancer and its metastases and to explore the implications of these developments for oncology nurses. Published papers, abstracts, research result, package inserts, books, and personal experience. Benign and malignant tumors can arise from any of the structures contained within the parapharyngeal space.
Understanding is evolving that cancer is a genetic disease that occurs when a single cell and its progeny are remarkably changed by a series of genetic mutations. A new paradigm for managing cancer is emerging that is based on new prognostic indicators, intracellular and intercellular communication, and biologic control.
Potential new therapeutic strategies include gene-directed therapy, control of cellular proliferation, exploitation of cell death, inhibition of metastasis, and reversal of multidrug resistance. Also, malignant tumors from adjacent areas (eg, the pharynx) can extend into the parapharyngeal space by direct growth, or distant tumors may metastasize to the lymphatics within the space.
Many of these therapies are only beginning to enter phase I/II clinical trials. The surgical approach chosen should facilitate complete tumor extirpation with minimal morbidity. An appliance for repositioning the proximal segment was applied, and the bony segments were fixed with titanium screws. Nurses with creativity and drive will continue to lead the way in developing management strategies for patients receiving these new therapies. Irradiation is administered as primary therapy in patients with unresectable tumors, poor surgical candidates, and selected other patients.
With continued progress, doctors will be able to identify patients with the highest likelihood of experiencing recurrent or progressive disease and formulate therapeutic strategies specific for their disease and even for their individual genetic makeup. To remain abreast of these new and increasingly sophisticated treatments, oncology nurses must be knowledgeable about cell and cancer biology, human genetics, the immune system, a how advances in these fields are forming the foundation for new therapies.
Although the history and physical examination can provide clues to the site of origin and nature of a parapharyngeal space tumor, imaging studies are more useful for defining the site of origin and extent of the mass, as well as its vascularity and relationship to the great vessels of the neck and other neurovascular structures.
Radiation therapy is also used after surgery for high-grade malignancies or when wide surgical margins cannot be achieved. This study suggests that use of mydriatic sprays on closed eyelids is as efficacious as use of mydriatic drops in open eyes for children. Patients with a history of oral malignancy were assessed by clinical examination followed by application of toluidine blue.
The purpose of this study was to evaluate postoperative stability in prognathic patients with mandibular asymmetry who were treated with sagittal split ramus osteotomy of the mandible. Changes in the positions of the standard points were examined on lateral cephalograms, and changes in the widths of the gonion points were examined on posteroanterior cephalograms.
Ten asymmetric (group I) and 11 symmetric (group II) patients were examined. Cephalograms were obtained preoperatively, 2 to 3 days postoperatively, and 3 and 6 months after surgery. Statistical analysis revealed no significant difference between the two groups. This study evaluated the utility (usefulness) of toluidine blue application as an aid to the recognition and diagnosis of clinically evident lesions in a series of patients previously treated for oral cancer and monitored in a cancer center. In addition to increased risk of recurrence of cancer or new second primary lesions, patients who have had previous treatment for oropharyngeal cancer may be more difficult to assess because of tissue changes that occur as a result of previous radiation therapy.
In addition, there was no significant difference between the postoperative changes in the widths of the gonion points on the deviated and nondeviated sides in group I. This study suggests that application of an appliance for repositioning the proximal segment can minimize postoperative skeletal changes in patients with asymmetry.