Chapter 9 H&N W&L chapter 33

What % of H&N cancers do submandibular and sublingual salivary gland tumors make up?`

2 to 3%

What dose will cause Erythema?

2000 cGy

What dose will cause dry mouth?

2000 cGy

What dose will cause Lhermitte sign?

2000-3000 cGy

What dose will cause mucositis?

3000 cGy

When does mucositis/stomatis-inflammation of the oral mucous membranes with edema and tenderness occur?

3000 cGy

What dose will cause Ears?

4000 cGy

What dose will cause dry eye?

4000 cGy

What is the dose to large fields?

45 Gy; reduced off the spinal cord and continued to 70Gy

What dose will cause spinal cord?

4500 cGy

When is the spinal cord blocked?

45Gy

What is the dose used to treat nasopharynx?

50 to 70 Gy with electron boost and special consideration to spinal cord, optic nerve, pituitary and brainstem

What is the dose to clinically negative nodes?

50-54Gy

What dose will cause cataracts?

500-1000 cGy

What are the typical curative doses for any subclinical disease?

5000 cGy

What are the typical curative doses to nodes in the H&N?

5000 cGy

What dose will cause laryngitis?

5000 cGy

What dose will cause optic nerve?

5000 cGy

What dose will cause retina?

5000 cGy

What are the RT doses for oral cavity?

5000 to 7000 cGy with opposed laterals and boost fields

What dose will cause mandible, teeth and gums?

5000-6000 cGy

What dose will cause brachial plexus?

5500 cGy

What are the postoperative RT doses?

60 to 63Gy, external beam, wedged pair technique with coned down boost

What are the postoperative RT doses for parotid?

60-63Gy 70-75Gy if gross residual disease

What dose will cause trismus?

6000 cGy

What are the typical curative doses for T1 lesions?

6000-6500 cGy

What is the dose with node dissection?

60Gy

What are the typical curative doses for T2 lesions?

6500-7000 cGy

What is the RT treatment forT3-T4 oropharyngeal and T2 base of tongue?

70-81.6 Gy

What are typical curative doses for T3-T4 lesions?

7000-7500 cGy

What dose rate is recommended for unresectable tumors?

70Gy

What is RT dose hyperfractionated to?

70Gy

What % of sinus cancers does maxillary make up?

80% of all sinus cancers with a 2:1 male prevalence

6. What is the name of the leaf-shaped cartilage that protects the larynx? a. glottis b. epiglottis c. pharynx d. larynx

ANS: B The epiglottis protects the pharynx. REF: Chapter 33, Head and Neck Cancers, p. 724

What may be used when a massive tumor exists that involves the nasopharynx, base of skull, sphednoidal sinuses, brain or optic chiasm?

RT

What is common type of oral cancer?

SCC

What is the common cancer of hypopharynx?

SCC

What is the common type of larynx cancer?

SCC

What type of cancer is common in nasopharynx?

SCC

What type of cancer is common in oropharynx?

SCC

The two most common etiologic factors contributing to H&N cancers are a. smoking b. heredity c. alcohol d. environmental

a and c

The treatment field for a primary tumor in the hypopharynx includes node of rouviere. A sharp field edge is needed to avoid and protect the a. spinal cord b. base of the brain c. larynx d. epiglottis

a spinal cord

What is the function of the hyoid bone? a. acts as an attachment site for muscles associated with swallowing b. prevents food from entering the trachea c. protects the delicate vocal cords d. acts as a base for the laryngeal cartilages to rest on

a.

More than 80% of H&N cancers arise from the surface epitelium of the mucosal linings of the upper digestive tract are a. adenocarcinomsa b. squamous cell carcinoma c. transitional cell carcinoma d. seminoma cancer

b. SCC

Multiple tumor types are included in the head and neck region. Which type of primary tumor is most common? a. adenocarcinoma b. SCC c. basal cell carcinoma d. fibrosarcoma

b. SCC

The majority of H&N cancers arise from epithelial surfaces and mucosal linings of the upper digestive tract and are mostly a. adenocarcinoma b. SCC c. lymphomas d. keratinized carciinoma

b. SCC

a mouth stent or tongue blade may serve more than one purpose in use during irradiation treatments to head and neck cancers. they may serve to separate or ___ the palate a. moisten b. displace c. keep still d. keep patient from swallowing

b. displace

What normal tissue would be at most risk of radiation damage when treating the maxillary antrum? a. brain b. eye c. skin d. pituitary

b. eye

which of the following is considered at the most risk when treating the maxillary antrum with radiation a. brain b. eye c. skin d. pituitary

b. eye

Postcricoid and pyriform sinuses are located in which of the following? a. oropharynx b. hypopharynx c. ethmoid sinuses d. maxillary sinuses

b. hypopharynx

The highest rate of nodal metastasis in all head and neck cancers is found with cancers in the a. oropharynx b. hypopharynx c. nasopharynx d. maxilary sinus

b. hypopharynx

Which of the following is typically the largest vascular structure in the neck a. common carotid artery b. internal jugular vein c. internal carotid artery d. external carotid artery

b. internal jugular vein

The most commonly involved site for malignancy of the sinuses would be a. ethmoid b. maxillary c. sphenoid d. frontal

b. maxillary

The tonsils are the most common site of disease in which of the following area? a. oral cavity b. oropharynx c. nasopharynx d. hypopharynx

b. oropharynx

For patients with carious teeth, when is dental work recommended when anticipating oral cavity irradiation a. following treatment b. preceeding treatment c. both a and b d. neither a and b

b. preceeding treatment

The jugulodigastric node may also be referred to as a node of rouviere b. subdigastric node c. retropharyngeal nodes d. circle of willis

b. subdigastric node

Which of the following is found at the base of the tongue a. uvula b. vallecula c. tonsillar fossa d. posterior pillat

b. vallecula

What makes up the oropharynx?

base of tongue tonsillar fossa soft palate pharyngeal walls

What is the oropharynx made of

base of tongue, tonsils (fossa and pillars) soft palate, and oropharyngeal walls

Why has regional recurrence been a challenge with H&N?

because of dose limiting factors

What is the clinical presentation of nasopharyngeal cancers?

bloody discharge auditory dysfunction respiratory dysfunction cranial nerve involvement (III, V, VI, IX, XII)

In some h&N cancers, the supraclavicular area is often treated if there is advanced disease or lower involved nodes. The normal dosage of irradation to this area a. 2500 cGy b. 3000 cGy c. 5000 cGy d. 6500 cGy

c 5000 cGy

How many cartilages make up the larynx? a. 3 pair b. 6 pair c. 9 d. 12

c. 9

A tumor confined to the larynx with cord fixation in glottic cancer is staged a. T1 b. T2 c. T3 d. T4

c. T3

What is the largest salivary gland?

parotid

What are concerns with H&N RT?

periodontal disease and caries maintaining adequate nutrition

What is the lymph drainage of the supraglottis?

peritracheal, cervical, submental and submaxilary nodes

What's the clinical presentation of larynx cancers?

persistent sore throat hoarseness and stridor cervical lymph node-supraglottic lesions

What is the role of the parotid salivary gland?

play a role in digestion and tooth protection

What are clinical presentations of oral cancers?

poor oral and dental hygiene Plummer-Vinson syndrome Leukoplakia/erythroplasia nonhealing ulcers squamous cell carcinoma common

What is the Nasopharynx made of

posterosuperior pharyngeal wall and lateral pharyngeal wall, eustachian tube orifice, and the adenoids

What is the main concern of parotid gland RT?

preservation of salivary function by sparing at least one parotid gland

What is the maxillary sinus?

pyramid shaped cavity lined by ciliated epithelium

What is the hypopharynx made of

pyriform siuses, postcricoid, and lower posterior pharyngeal walls below base of tongue

What is the treatment for poorly differentiated carcinoma of larynx?

radiation alone or concurrent with chemotherapy

What is the treatment for T1-2 of hypoparynx?

rare and could be treated with RT or surgery

What is the lymph drainage of nasopharynx?

retropharyngeal nodes into the superior jugular and posterior cervical nodes Lateral retropharyngeal node (node of Rouviere)

What drains the pharyngeal walls?

retropharyngeal nodes, pharyngeal nodes, jugulodigastric nodes

What are risk factors of head and neck cancer?

tobacco and alcohol

What H&N cancers are associated with HPV?

tongue, floor of the mouth, tonsils

When will taste changes occur?

1000 cGy

19. Which of the following is not considered a risk factor for larynx cancer? a. Epstein-Barr virus b. poor nutrition c. alcohol abuse d. human papillomavirus

ANS: A Epstein-Barr virus has been associated with nasopharyngeal carcinoma but not larynx cancer.

18. Which salivary gland is associated with the Stensen duct? a. parotid b. submandibular c. sublingual d. minor

ANS: A The Stensen duct can become obstructed. This enlarges the parotid gland, thereby necessitating surgical intervention.

3. In which salivary gland do most salivary cancers occur? a. parotid b. submandibular c. sublingual d. minor

ANS: A The parotid is the site of highest incidence of salivary glands tumors (80% to 90%).

21. Which of the following is not a division of the pharynx? a. parapharynx b. nasopharynx c. oropharynx d. laryngopharynx

ANS: A The pharynx is subdivided into three anatomic divisions: the oropharynx, nasopharynx, and hypopharynx, also referred to as the laryngopharynx.

9. What defines the superior radiation field border for the treatment of a low staged larynx cancer? a. superior aspect of the hyoid b. cricoid cartilage c. inferior aspect of the mandible d. roof of the mouth

ANS: A The superior border of a low staged laryngeal cancer is set at the location of the superior aspect of the hyoid or at the upper thyroid notch.

20. Which anatomic structure contains the true vocal cords? a. glottis b. epiglottis c. pharynx d. larynx

ANS: A The true vocal cords are also known as the glottis.

5. What structure of the neck is also known as the glottis? a. true vocal cords b. false vocal cord c. vestibular folds d. nasal turbinates

ANS: A The true vocal cords are also known as the glottis. REF: Chapter 33, Head and Neck Cancers, p. 729

1. After what dose of radiation does xerostomia typically first occur? a. 1000 to 2000 cGy b. 2000 to 3000 cGy c. 3000 to 4000 cGy d. 4000 to 5000 cGy

ANS: A Xerostomia occurs after 1000 to 2000 cGy and may be permanent after 4000 cGy.

15. What T stage is a glottic tumor that involves both vocal cords but does not impair mobility? a. T1a b. T1b c. T1c d. T2

ANS: B According to the AJCC staging system, T1b can describe a glottic tumor that involves both vocal cords.

4. Radiation therapy of which of the following cancers does not include regional lymph nodes? a. early staged parotid b. early staged larynx c. early staged nasopharynx d. all of the above include regional lymph nodes

ANS: B Limited risk of subclinical disease to the cervical lymphatics in the treatment of Tis and T1 lesions indicate a field encompassing the primary lesion only.

13. What condition frequently develops in users of smokeless tobacco? a. erythroplakia b. leukoplakia c. thrush d. dysplasia

ANS: B Smokeless tobacco users frequently develop premalignant lesions, such as oral leukoplakia, at the site where the tobacco quid rests against the mucosa.

10. What defines the inferior radiation field border for the treatment of a low staged larynx cancer? a. superior aspect of the hyoid b. cricoid cartilage c. clavicles d. C7-T1 intervertebral space

ANS: B The inferior border of a low staged laryngeal cancer is set at the cricoid cartilage (lower border of C6).

8. What defines the posterior radiation field border for the treatment of a low staged larynx cancer? a. posterior aspect of the hyoid b. anterior aspect of the vertebral body c. mid-vertebral body d. posterior aspect of the vertebral body

ANS: B The posterior border of a low staged laryngeal cancer is set just anterior to the vertebral body, including the anterior portion of the posterior pharyngeal wall.

14. What is the most common presenting symptom of larynx cancer? a. sore throat b. persistent cough c. hoarseness d. difficulty breathing

ANS: C A persistent sore throat and hoarseness are classic presenting symptoms of laryngeal cancer.

12. What is the most common form of larynx cancer? a. adenocarcinoma b. basal cell c. squamous cell d. transitional cell

ANS: C More than 80% of head and neck cancers arise from the surface epithelium of the mucosal linings of the upper digestive tract and are mainly squamous cell carcinomas.

11. What is the most common histological type of head and neck cancer? a. adenocarcinoma b. transitional cell carcinoma c. squamous cell carcinoma d. renal cell carcinoma

ANS: C More than 80% of head and neck cancers arise from the surface epithelium of the mucosal linings of the upper digestive tract. These cancers are mostly squamous cell carcinomas.

16. What T stage is a glottic tumor that involves only one vocal cord but does impair mobility? a. T1a b. T1b c. T1c d. T2

ANS: D According to the AJCC staging system, T2 can describe a glottic tumor that extends to supraglottis and/or subglottis and/or with impaired cord mobility

17. Which of the following is a function of saliva? a. lubricate the food bolus b. digestion c. oral hygiene d. all of the above

ANS: D Saliva and the salivary glands have major roles in digestion and tooth protection.

7. What is commonly referred to as the voice box? a. vestibular folds b. epiglottis c. pharynx d. larynx

ANS: D The larynx is commonly referred to as the voice box.

2. After what dose of radiation may xerostomia become permanent? a. 1000 to 2000 cGy b. 2000 to 3000 cGy c. 3000 to 4000 cGy d. 4000 to 5000 cGy

ANS: D Xerostomia occurs after 1000 to 2000 cGy and may be permanent after 4000 cGy.

2. Chemotherapy is an effective treatment for salivary gland tumors.

ANS: F Chemotherapy is not a treatment option described for salivary glands tumors.

5. Most salivary gland cancers are squamous cell carcinomas.

ANS: F Histologically, the more common cell types for malignant tumors are the adenoid cystic, mucoepidermoid, and adenocarcinoma.

7. Laser excision is the most common treatment for T3 laryngeal cancers.

ANS: F Large T3-4, transglottic lesions are treated with radiation alone. In the event of a recurrence, salvage surgery is an option.

8. Xerostomia is a common side effect associated with traditional radiation therapy for early larynx cancer.

ANS: F Limited risk of subclinical disease to the cervical lymphatics in the treatment of Tis and T1 lesions indicates a field encompassing the primary lesion only. Therefore, the salivary glands are outside the treatment volume.

1. Collectively, head and neck cancers are more common in women than men.

ANS: F The 2007 estimates according to the American Cancer Society Surveillance Research report indicate that of the total 766,860 estimated cancer cases in the country, 24,180 cancer cases (3%) will be of the oral cavity and pharynx for males. Females will present 10,180 oral cavity/pharynx cases (1.3%).

3. Over the past decade, the incidence of larynx cancers is on the rise.

ANS: F The SEER reports that head and neck cancer shows a significant decreasing trend over the period of 1995 to 2004. Larynx cancer is reported to have the greatest decreasing trend for that time period.

6. The primary function of the oral cavity is respiration.

ANS: F The organs comprising the head and neck region serve dual purposes in that respiratory and digestive activities take place.

4. Most larynx cancers are discovered early.

ANS: T A persistent sore throat and hoarseness are classic presenting symptoms as early stage larynx cancer. In addition, carcinoma in situ (Tis) is rather common on the vocal cords.

The main goals in treating head and neck cancers and determining the best modality of treatment are a. eradication of disease b. maintenance of physiologic function c. preservation of social cosmesis

All of them

many structures and soft tissue of the aerodigestive track within the facial/cervical regions can be directly examined by means of a. palpation b. direct inspection c. biopsy

All of them

What are the RT borders for oropharynx?

Anterior - 2cm from known tumor Superior - 1.5 to 2cm superior to the soft palate Posterior - posterior spinous processes Inferior - level of the hyoid

What are the RT borders of the oral cavity?

Anterior- anterior portion of mandible (excluding lower lip) Posterior - behind vertebral bodies or spinous process Superior - 1.5 cm above the tongue Inferior - thyroid notch

When diagnosing nasopharynx what virus will they do a test for?

Epstein-Barr virus EBV

What cranial nerve is affected?

Facial Nerve VII-causes paralysis

What are the RT borders of nasopharynx?

Superior - 2 cm beyond tumor to include base of skull and sphenoid sinuses Posterior - 2cm margin beyond mastoid process, or posterior margin may extend further to allow a 1.5 cm margin on enlarged nodes Anterior - to include the posterior third of the maxillary sinus and nasal cavity, careful attention to adequate margin (2cm) for more anterior tumors Inferior - thyroid notch to allow sparing of larynx Lower neck - anterior supraclavicular field with larynx block

What are the RT borders of hypopharynx?

Superior - inferior border of mandible and mastoid process, to base of skull Inferior - lower border of the cricoid cartilage; 1.5 to 2.0 cm margin Anterior - in front of the thyroid cartilage "shine off" (fall off) if larynx involved Posterior - behind the spinous process

What are the RT borders for parotid gland?

Superiorly - zygomatic arch or higher Anteriorly - anterior edge of the masseter muscle Inferior - thyroid notch Posterior-just behind mastoid

What is treatment for small lesions of nasal septum or those limited to the infrastructure of the maxillary sinus?

Surgery

What is the treatment for T2-4

Surgery and large radiation fields

What age group normally gets maxillary sinus cancer?

over age 40

Displacement of the eye can happen in maxillary sinus cancer?

True

Postcricoid cancers occur predominantly in women

True

Plummer-Vinson syndrome often seen in females, is considered an important etiologic factor in which of the following cancers a. oral cavity b. oropnarynx c. nasopharynx d. hypopharynx

a. oral cavity

The primary lymphatic drainage of the lower lip would be a. submental nodes b. submaxilary nodes c. subdigsatric nodes d. the posterior cervical chain

a. submental nodes

The usual wedge pair technique often used in treatment of the parotid gland is a. superior/inferior oblique combination b. anterior/posterior oblique combination c. anterior/posterior combination d. anterior/inferior oblique combination

a. superior/inferior oblique combination

The most common sign/symptom of oral cancer is a. ulceration b. hoarseness c. odynophagia d. xerostomia

a. ulceration

What are the types of parotid cancer?

adenoid cystic, mucoepidermoid and andenocarcinoma

When does xerostoima-dry mouth

after 1000 to 2000 cGy and may be permanent after 4000 cGy

What is the Oral Cavity made of

anterior 2/3 of tongue, lip, buccal mucosa, retromolar trigone, floor of the mouth, hard palate

What will cataract formation if lens is treated occur?

as low as 1000 cGy

What is the clinical presentation of parotid cancer?

asymptomatic mass lasting 4-8 months localized swelling of face, pain, facial palsy

Which of the following lymph node area is very high risk for dissemination of disease, is inaccessible for surgery, and therefore must be included as the minimum target volume when treating the nasopharyngeal area a. waldeyer ring b. Rouviere nodes c. Circle of Willis d. jugulodigastric nodes

b Rouviere nodes

About ___ of the body's lymph nodes are located in the H&N? a. 1/4 b. 1/3 c. 2/3 d. 1/2

b. 1/3

The ___ nodal group, below the mastoid tip, receives nearly all of the lymph from the head and neck area and is often included in the treated area a. submandibular nodes b. carotid nodes c. jugulodigastric nodes d. rouviere nodes

c. jugulodigastric nodes

The most commonly involved group of nodes in the oropharyngeal cancer is the a. submandibular nodes b. retropharyngeal nodes c. jugulodigastric nodes d. supraclavicuar nodes

c. jugulodigastric nodes

Palpation of the cricoid cartilage indicates the inferior border of the a. oral cavity b. oropharynx c. larynx d. hypopharynx

c. larynx

The most common site of distant metastatic disease from the H&N ares is the a. brain b. bone c.lung d. liver

c.lungs

What is SCC of the maxillary sinus and nasal cavity associated with?

chemical agents found in nickel refinery and leather tanning

What is the treatment for veracious carcinoma of larynx?

conservative surgery

What is the RT treatment for T1-T2 soft palate, tonsil, pharyngeal wall and tongue?

conventional 66-70Gy

What are the boundaries of the Nasopharynx?

cuboidal structure lying on a line from the zygomatic arch to the EAM, extending inferiorly to the mastoid tip. located behind the nose and extends from the posterior nares to the level of the soft palate

Which of the following is not considered part of the oral cavity? a. buccal mucoas b. hard palate c. floor of the tongue d. soft palate

d soft palate

In treating the oropharynx area with conformal treatment (IMRT) all of the following structures can be avoided except? a. temporomandibular joint b. part of the pterygoid muscles c. salivary glands d. tonsils

d tonsils

Tumors of the H&N may involve the cranial nerves that control our major senses. This may lead to signs and symptoms that can point to a possible location of a tumor. The cranial nerve that may be involved in facial paralysis is the cranial nerve a. XII b. I c. VIII d. VII

d. VII

Tumors of the H&N may involve the cranial nerves that control our major senses. This may lead to signs and symptoms that can point to a possible location of the tumor. which are would be the most common for involvement of cranial nerves? a. oral cavity b. oropharynx c. hypopharynx d. nasopharynx

d. nasopharynx

What muscle divides the neck into anterior and posterior triangles? a. trapezius b. pterygoid c. longissimus dorsi d. Sternocleidomastoid

d. sternocleidomastoid

What are the borders of the oral cavity?

extends from the skin-vermilion junction of the lip to the posterior border of the hard palate superiorly and to the circumvallate papillae inferiorly

What is the lymph drainage of the glottis?

extremely rare for nodal involvement

Where do carcinomas arise in the maxillary sinus?

from ciliated epithelium or mucous glands

What does the larynx consist of?

glottis supraglottis subglottis

What is the larynx made of

glottis, supraglottis, subglottis

Which are more radiosensitive helophytic or infiltrative lesions?

helophytic

Where do the majority of salivary gland malignancies occur?

in the parotid however, 2/3 of tumors in salivary glands are benign and salivary malignancies are rare

What is the lymph drainage of the subglottis?

into the peritracheal and low cervical nodes

What is Plummer-Vinson syndrome?

iron deficiency in females

What drains the soft palate?

jugulodigastric, submaxillary and spinal accessory nodes

What drains the tonsillar fossa?

jugulodigrastic and submaxillary nodes

What drains the base of tongue?

jugulodigrastic, low cervical, and retropharyngeal nodes

What will the target volume for parotid include?

local invasion and lymphatics involved

What H&N cancer is associated with the Epstein-Barr virus (EBV)?

nasopharynx

There are lymphatics in the maxillary area; so maxillary sinus tumors spread through lymphatics?

no, they rarely involve regional lymphatics

What are the RT borders for the Supraglottic and subglottis?

often much larger fields Fields should include jugulodigastric, anterior and posterior cervical and supraclavicular lymph nodes

What RT fields are used to treat nasopharyngeal?

opposing lateral fields to cover tumor and possible pathways of spread supraclavicular area

When will the lacrimal glands be affected and cause dry painful eye?

severed dry eye syndrome is reported in 100% of patients receiving more than 5700 cGy

What are the clinical presentation of Hypopharynx (pyriform sinuses) cancers?

sore throat odynophagia neck mass dysphagia (hallmark of postcricoid carcinoma) weight loss

What are the clinical presentations of oropharynx (tonsils) cancers?

sore throat pain on swallowing upper spinal nodal swelling referred otalgia

What is the lymph drainage for lips?

submandibular, preauricular, and facial nodes

What is the lymph drainage for floor of mouth?

submaxillary and jugular (middle and upper nodes)

What is the lymph drainage for gingiva?

submaxillary and jugular nodes

What is the lymph drainage for the retromolar trigone?

submaxillary and jugulodigastric nodes

What is the lymph drainage for buccal mucosa?

submaxillary and submental nodes

What is the lymph drainage for hard palate?

submaxillary and upper jugular nodes

What is the lymph drainage for the anterior 2/3 of the tongue?

submaxillary and upper jugular nodes

What are the RT borders for the Glottis?

superior - upper thyroid notch Inferior- cricoids cartilage (lower border of C6) Anterior- 1 to 1.5 cm shine over (flash) over the skin surface at the level of vocal cords Posterior - just anterior to the vertebral body, including the anterior portion of the posterior pharyngeal wall

What is the lymp drainage of hypopharynx?

superior deep, middle and low jugular nodes Rouviere (lateral retropharyngeal lymph nodes at base of skull)

What is the treatment for parotid cancer?

surgery RT postoperatively for residual, recurrent, or inoperable lesions

What is treatment for advanced stages of maxillary cancers?

surgery and postoperation RT

What is the treatment for advanced lesions of larynx?

surgery and postoperative radiation

What is the treatment for early lesions of larynx?

surgery or radiation

The roof of the maxillary sinus is the floor of?

the orbit

What cranial nerves may be involved with maxillary sinus cancer?

the trigeminal nerve V

What type field arrangements are used for parotid glad RT?

wedged field technique superior and inferior oblique combination; opposed lateral field if target estends beyond midline

When is surgery used for treatment of oral cavity?

when tumors are smaller than 1.5 cm

What is adenocarcinoma of nasal cavity and ethmoid sinus associated with?

wood dust exposure

Is hyperfractionation and radiosensitizers used in RT of oral cavity?

yes

Is chemotherapy used in oral cavity treatment?

yes, can be used in combination and may be given in sequence or concurrent with RT

Does the parotid have lymph drainage?

yes, extensive lymphatic capillary plexus