Chapter 39: Managing Oral & Esophageal Disorders

Coverage includes common oral conditions such as periodontal disease and dental caries, emphasizing hygiene, dietary habits, and systemic health connections, alongside specific abnormalities like actinic cheilitis, candidiasis, and leukoplakia. Jaw disorders, including temporomandibular issues and fractures requiring interventions like open reduction internal fixation (ORIF), necessitate careful postoperative management involving diet modification and infection control. Inflammation and tumors of the salivary glands, such as parotitis and sialadenitis, are addressed, with therapeutic options ranging from antibiotics and hydration to lithotripsy for salivary calculi. A major segment is dedicated to cancers of the oral cavity and pharynx, where the synergistic risk factors of tobacco, alcohol, and HPV are highlighted, leading to treatments that often combine surgery, radiation, and complex reconstructive surgery involving tissue flap transfers. The discussion transitions to the crucial topic of enteral nutrition, defining it as the infusion of specialized formulas directly into the gastrointestinal tract, which is preferred when oral intake is compromised but the gut remains functional. The nurse must expertly administer continuous, cyclic, or bolus feedings, carefully monitoring formula osmolality, flow rate, and potential complications like dehydration or dumping syndrome (the rapid entry of hyperosmolar contents into the small intestine). For long-term access, surgical placement of gastrostomy or jejunostomy tubes is detailed, requiring rigorous attention to site care, patency maintenance, and the prevention of infection or dislodgement. Finally, the chapter comprehensively reviews esophageal conditions, starting with motility disorders like achalasia (absent peristalsis, treated with dilation or myotomy) and esophageal spasms. Structural issues include hiatal hernias (sliding or paraesophageal) and diverticula (like Zenker's), often managed through conservative strategies or surgical fundoplication. Special attention is given to gastroesophageal reflux disease (GERD) due to its link with Barrett Esophagus (BE), a premalignant condition. Treatment for advanced esophageal cancer, which carries a high mortality rate, typically involves multi-modality approaches, including esophagectomy, followed by highly specialized postoperative care focused on respiratory function, leak detection, and managing post-surgical complications like vagotomy syndrome.