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Disfigurement and Dysfunction Scales After Head and Neck Cancer Surgery

Purpose: To determine the degree of disfigurement and dysfunction following head and neck cancer surgery using the scales of Dropkin et al.

Description

Cancer surgery for head and neck tumors can result in permanent disfigurement and dysfunction. Severity scales for disfigurement and dysfunction were developed by Dropkin et al at Memorial Sloan-Kettering Cancer Center in New York City.

 

General observations:

(1) Greater disfigurement is associated with tissue removal in the central portion of the face as opposed to the periphery. The central portion of the face provides greater audiovisual stimuli in interactions with others.

(2) Since 3 of the major sense organs are centrally located, resection of the central portion of the face may be associated with more significant dysfunction.

(3) Surgery on the mandible may be associated with both significant disfigurement and dysfunction.

 

Surgery

Rank Order for Disfigurement

radical neck dissection

1

cheek resection with forehead flap repair

2

total parotidectomy with facial nerve sacrifice

3

total laryngectomy

4

bilateral radical neck dissection

5

orbital exenteration

6

hemimandibulectomy and radical neck dissection

7

nasal amputation

8

anterior partial mandibulectomy

9

segmental mandibulectomy and radical neck dissection

10

orbital exenteration and radical maxillectomy

11

from Table 1, page 561

 

Functional Loss

Rank Order for Dysfunction

loss of smell

1

unilateral hearing loss

2

impaired mastication

3

impaired speech

4

unilateral loss of vision

5

impaired control of salivary secretions

6

impaired deglution

7

aphonia

8

from Table 2, page 561

 

where:

• The following are not listed: bilateral loss of hearing, bilateral loss of vision, inability to swallow.

 


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Specialty

Objective

ICD-10