[Dysphagia] oral cancer patient

[allison_bartlett at health.qld.gov.au (Allison Bartlett)]

I'm hoping someone can give me some suggestions regarding the management of a patient,
68 y o woman with extensive lingual cancer, surgical removal of total tongue base, resection of left side of tongue, removal of one hypoglossal nerve, partial epiglottis removal, partial hyoid removal.

This lady has extremely reduced tongue range of movement, has a PEG inserted as well as a trache (with swedish nose attached), copious amounts of secretions are being suctioned via the trache, the patient is also able to cough secretions out of the trache. Since the operation the pt has had one aspiration pneumonia but in the 2 weeks since, chest has been clear, she is now 4 weeks post. This pt also has previous history or XRT to the mouth/neck area.

Any suggestions for reducing the amount of secretions, would removing the trache help to reduce secretions? Would a Passy-Muir speaking valve be better than a swedish nose?
Her ENT is pushing for laryngectomy to prevent aspiration but I have advised against this as patient will be unlikely to achieve effective communication with servox or VP due to poor movement of what remains of the tongue. Patient is able to be understood when speaking although there is obvious dysarthria.
Patient is unable to swallow her saliva, or various consistencies of thickened fluids due to severe oral dysphagia, and is unlikely to eat/drink orally. 

Any suggestions would be appreciated,

Allison Bartlett
AUSTRALIA




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