Airway+Protection+Strategies

Airway Protection Strategies

***It is important that any airway protection techniques are performed during the VFSS to make sure the patient is doing them properly and to determine the impact on aspiration and swaloowing motility, (Pauloski,2008). ** *

==Supraglottic and super-Supraglttic Swallow Maneuvers == The supraglottic and super-supraglottic swallow maneuvers are techniques that are used to protect the airway from potential aspiration of food and / or liquid by closing the airway before swallowing ( Groher & Crary,2010). For the supraglottic swallow the patient is asked to "take a deep breath and hold it, swallow while continuing to hold the breath and cough immediatly after the swallow to expel any residue from the airway entrance"( Pauloski,2008). The Super Supraglottic swallow aims to close the entrance into the airway by tilting the arytenoid cartillage anteriorly which will then contact the base of the epiglottis before and during the swallow, and it closes the false vocal folds tightly ( Pauloski,2008). Instructions given to the patient to perform the supraglottic swallow could be "inhale and hold your breath very tightly bearing down, keep holding your breath and bearing down when you swallow and cough when you are finished "(Pauloski 2008). Endoscopic investigation has shown that the supraglottic maneuver may not always achieve true chord closure, but the super supraglottic maneuver has an additional level of protection because it tilts the arytenoids anteriorlly to contact the base of the epiglottis Martin,Logemann, Shaker, et al., 1993).This manueuver has been shown to be very effective for eliminating aspiration in patients who have undergone radiotherapy to the head and neck ( Logemann , Pauloski, Rademaker, Cathy, Lazarus, Mittal, Gaziano, Stachowiak, MacCracken, Newman ,1997). Depending on the portion and amount of the tongue that is resected , these swallow maneuvers can be an effective technique to help protect the airway in patients who have undergone a partial glossectomy with radiotherapy.

 __Pharyngeal Expectoration__
==== Pharyngeal expectoration really is just a fancy term for asking the patient to cough.As previously mentioned, patients who have undergone radiotherapy to the head and neck post tongue cancer can have significantly reduced oral transit times , increased pharyngeal residue and decreased cricopharngeal opening. A useful way of trying to get rid of extra secreions is by getting the patient to cough after swallowing (Kazi,2003). ====

Modifying Liquids and Diets