7/27/2019 Evaluation and Management of Glossectomy
1/54
Evaluation and management of
glossectomy
KUNNAMPALLIL GEJO JOHN
BASLP, MASLP
7/27/2019 Evaluation and Management of Glossectomy
2/54
Oromotor exercise
7/27/2019 Evaluation and Management of Glossectomy
3/54
The inability to eat or todrink is not an acceptableway of living
Buset and Cremer
1992.
7/27/2019 Evaluation and Management of Glossectomy
4/54
The speech therapist
perspective
Swallowing - vegetative basic biologicalfunction of life
-a necessity for survival
Speech - an overlaid function
- necessary for socialcommunication
The organs serving the two function is theoral cavity associated with respiratoryand laryngeal systems
7/27/2019 Evaluation and Management of Glossectomy
5/54
Swallowing rehabilitationarecent development !
Understanding swallowing physiology
Evaluation of disability in objective terms VizOPSE video fluoroscopy mod. Ba swallow
Swallowing Rx Speech pathologists domain
Preventing/pre-empting of Aspiration..
Learning from Quality of life perspectives .
7/27/2019 Evaluation and Management of Glossectomy
6/54
7/27/2019 Evaluation and Management of Glossectomy
7/54
Disability- post resection
An appraisal
Impact swallowing
Bolus preparation
Bolus propulsion
Bolus residueInadequate nutrition
Aspiration
7/27/2019 Evaluation and Management of Glossectomy
8/54
Oropharynx oral cavity
Base of tongue
Tonsils
Vallecula
Mobile tongue
7/27/2019 Evaluation and Management of Glossectomy
9/54
Swallowing physiology
Four Impt phases
Voluntary phase
oral preparatory phaseoral phase
Involuntary phase
pharyngeal phase
esophageal phase
7/27/2019 Evaluation and Management of Glossectomy
10/54
Oral & Pharyngeal Phases- Scopefor Intervention
7/27/2019 Evaluation and Management of Glossectomy
11/54
Swallowing process
FoodTonguemovement
Pharyngealphase
Bolus passing
throughesophagealarea
7/27/2019 Evaluation and Management of Glossectomy
12/54
Lateral tonguelesion
7/27/2019 Evaluation and Management of Glossectomy
13/54
Posteiortongue
lesion
7/27/2019 Evaluation and Management of Glossectomy
14/54
Oral cancer surgical resection
Structural deviation
Functional deficits
Constant flow of salivaFacial altered counter
Impaired speechMastication affected
Interrupted airway
temporarily
7/27/2019 Evaluation and Management of Glossectomy
15/54
Surgically related Dysphagia
Dependent upon
1. Which anatomic structures areremoved
2. Extent of tissue removed
3. Presence of nerve damage
4. Type of reconstruction(flap/repair/sutures)
7/27/2019 Evaluation and Management of Glossectomy
16/54
Effect of glossectomy on swallowing
Reduced oral control with delayed oraltransit times
Sensory loss resulting in unwarned ofposition of food in mouth
Reduction in lip closure leading to loss ofmaterial from the mouth
Reduction in range , flexibility andstrength of tongue movements
7/27/2019 Evaluation and Management of Glossectomy
17/54
Difficulty in transferring food from the frontto back of oral cavity
Loss of bolus into pharynx prior to trigger ofthe swallow, leading to aspiration
Reduced or absent chewing action resultingin long term fluid diet
Nasal regurgitation or leakage, if the soft
palate has been affected Lack of velopharyngeal seal resulting in
insufficient intraoral pressure to assist inpropelling the bolus into pharynx
7/27/2019 Evaluation and Management of Glossectomy
18/54
Incoordination of swallow due toswelling and reduced sensation inpharynx
Damage to cranial nerve 9, 10, 12.11th nerve
Failure of the larynx to elevate fully
h h i l
7/27/2019 Evaluation and Management of Glossectomy
19/54
Speech Therapist role-Swallowing disorder
To maximize residual
function
To offer alternative
feeding options
7/27/2019 Evaluation and Management of Glossectomy
20/54
When should dysphagia
management begin?
Assessment andmanagement should bedone when healing is
complete withoutpostoperative complications
7/27/2019 Evaluation and Management of Glossectomy
21/54
SWALLOWING REHABILITATIONWHEN?
Healed Wound & no e/o Fistula
Preferably before RT ( Incorporate Amifostine)
Continue until mucositis makes it painful( after 20GY)Maintain Nutrition all the time ( PEG )
Recommence after 4-6 weeks after Last fraction RT
Continue for 6-8 months to prevent fibrosis & minimise
sequelEnhance Salivary flow with Sialogogues, Pilocarpine ,
7/27/2019 Evaluation and Management of Glossectomy
22/54
Swallowing assessmentinformal
Observe how the person handlessecretion
Examination of the structure &function of the oral structures
Cough reflex
Sign of aspiration Nutritional status of the patient
Interest of the patient for swallowing
Rx
7/27/2019 Evaluation and Management of Glossectomy
23/54
Swallowing assessment
vidiofluroscopic analysisModified barium swallow
Consistency of material-liquid/paste/cookie
Swallow measures----- OPSE
Indicates the efficiency ofswallowing for all the three food
materials
7/27/2019 Evaluation and Management of Glossectomy
24/54
Treatment timing
Before radiotherapy
During radiotherapy
After radiotherapy
Little and often practicedaily
Regular follow up
7/27/2019 Evaluation and Management of Glossectomy
25/54
Deglutitory disordersTONGUE
Mild ---- < 30% resection with tonguemobility
Severe --- >50% tongue resection
Impairs - lingual peristalsis, antr-postrbolus movts & pharyngeal phase
Increased oral phase Drooling of saliva
Reduced/absent chewing action
resulting in long term fluid diet
7/27/2019 Evaluation and Management of Glossectomy
26/54
Deglutitory disordersLIPS
Minimal
oral phase- reduction in lip closure
- loss of material frommouth
7/27/2019 Evaluation and Management of Glossectomy
27/54
Deglutitory disorderMANDIBLE
Severe if combined withglossectomy
Oral preparatory, oral&pharyngeal phase
Difficulty in chewingDrooling
7/27/2019 Evaluation and Management of Glossectomy
28/54
How to start management?
Explanation of surgery and itseffect
Altered swallowingphysiology
Food consistency forswallowing
Amount of material
7/27/2019 Evaluation and Management of Glossectomy
29/54
Reconstructed tongue after majorsurgery
7/27/2019 Evaluation and Management of Glossectomy
30/54
Total glossectomy
7/27/2019 Evaluation and Management of Glossectomy
31/54
Lower jaw cancer operated
7/27/2019 Evaluation and Management of Glossectomy
32/54
Partial glossectomy
Postoperative view
7/27/2019 Evaluation and Management of Glossectomy
33/54
Treatment of tongue cancer
Transoral excision
7/27/2019 Evaluation and Management of Glossectomy
34/54
Commandoprocedure
7/27/2019 Evaluation and Management of Glossectomy
35/54
Accumulationof saliva in theanterior part
of the oralcavity
Reconstructedarea
7/27/2019 Evaluation and Management of Glossectomy
36/54
No ligual/oral tongueto lateralfood
7/27/2019 Evaluation and Management of Glossectomy
37/54
Glossectomywith lip splitting
approach
fl f
7/27/2019 Evaluation and Management of Glossectomy
38/54
Tongue flapA type ofreconstruction of the defect
7/27/2019 Evaluation and Management of Glossectomy
39/54
How to start ?
Baseline dataMedical history
extent and site of
resectionType of
reconstruction
Oral cavitystructural andfunctional deficits
7/27/2019 Evaluation and Management of Glossectomy
40/54
Dysphagia management
Start after decannulation Oromotor exercise Compensatory methods
postural changeschange in foodconsistency
Directional maneuvers
supraglotticswallowsuper supraglottic
swallow
7/27/2019 Evaluation and Management of Glossectomy
41/54
Dysphagia program
Information giving about alteredswallowing physiology
Positive, supportive and realisticassurance
Constant family support
Assessment of respiratoryproblem
Decannulation of tracheostoma
7/27/2019 Evaluation and Management of Glossectomy
42/54
Range of motion exercises
Start early-as soon as adequate healing
Ensure adequate pain control
Short frequent practice sessionsthroughout the day-5-10 min 10 times aday
Evaluate progress regularly
Potential to improve for up to 3 months
7/27/2019 Evaluation and Management of Glossectomy
43/54
7/27/2019 Evaluation and Management of Glossectomy
44/54
Oromotor exercises tongue
7/27/2019 Evaluation and Management of Glossectomy
45/54
Compensatory methods-5 T
Temperature
Taste
Total
Time
Texture
7/27/2019 Evaluation and Management of Glossectomy
46/54
7/27/2019 Evaluation and Management of Glossectomy
47/54
Swallowing therapy
7/27/2019 Evaluation and Management of Glossectomy
48/54
Compensatorymethod offeeding
7/27/2019 Evaluation and Management of Glossectomy
49/54
Feeding aidsHelps in bolus placement,
manipulation &transport in
oral cavity
1. Long handled feeding
spoon
2. Straw
3. Sippy cup
4. Cup with cut out fornose
5. Asepto syringe &catheter
7/27/2019 Evaluation and Management of Glossectomy
50/54
Swallowing therapy session
7/27/2019 Evaluation and Management of Glossectomy
51/54
Hints & tips on feeding
Pick times when patient is most alert
Ensure as upright and comp. position
Allow plenty of time to eat and ensure a relaxed
environment with no distractions is maintained Encourage patient to place food in non operated
side and tilt head to this side
Avoid mixed consistencies of food and drink Pay attention to food presentation
7/27/2019 Evaluation and Management of Glossectomy
52/54
Oral hygiene
Encourage patient to clear mouthafter each swallow
Carry put oral hygiene after eachmeal
7/27/2019 Evaluation and Management of Glossectomy
53/54
Each morning When awake
what will I eat today
how will I prepare it
how long will it takeme to eat
will I have to speak toanyone
will others understandmy speech
how long to continue
like this
7/27/2019 Evaluation and Management of Glossectomy
54/54
Physicians efforts are to bringback an individual from death
whereas
The rehabilitation professionals
efforts are to take him\hertowards meaningful life
Top Related