[Dysphagia] oral cancer patient

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

Unfortunately VP will not be an option because of her extremely limited tongue movement- she will not be able to articulate sufficiently for a VP/ TEP, not to mention the ongoing maintainence and cleaning, (I forgot to mention she is blind in one eye) . Also limited (almost nonexistent) tongue movement means the best she could do in regard to eating (if she were to have a laryngectomy) is 'dump and swallow' of a liquid diet. So I really don't want to take her voice away from her as well when the consensus these days seems to be that you can aspirate your secretions provided mouth cares are being taken care of.
 
 
 
 
Allison Bartlett
Speech Pathologist
Ipswich Hospital
 
07 3810 1308
 
Allison_Bartlett@heath.qld.gov.au

>>> "Jai Gupta" <GuptaJ@SESAHS.NSW.GOV.AU> 09/15/04 03:30pm >>>

I think she will be better off with laryngectomy ...after all the removals she has had ....I am surprised they did not gave her the option at all .... she can get TEP(transesophageal prosthesis) inserted that should give her speech and Servox is not needed and aspiration can be taken care of so also PEG can be eliminated and I think over all she will have better quality of life if she can eat and drink what she wants ...??? it is just my opinion ...I have seen few of them.


Jai Gupta. M.Sc.(S.H.) CPSP MSPA
Manager, Speech Pathology Services.
The Sutherland Hospital


-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On 
Behalf Of Allison Bartlett
Sent: Wednesday, 15 September 2004 2:06 PM
To: Dysphagia@b9.com 
Subject: [Dysphagia] oral cancer patient



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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