Potential+complications+and+side+affects++a+partial+glossectomy+radiation+therapy+that+may+contribute+directly+to+dysphagia

Swallowing problems after a partial glocectomy will depend on the extent of the resection, the structures resected and also the nature of the reconstruction, ( Pauloski,2008).When the viscosity of food or liquid increases, swallowing becomes more problematic ( Groher & Crary,2010). **Patients who have a portion of the tongue removed exhibit worsened swallow function characterised by: (we already know they will have had a portion removed so could you just say "possible signs:").**
 * Potential Complications and Side Effects that may Contribute to Dysphagia (could you make this title shorter as we have mentioned the population previously) ** It is important for the SLT to be aware of the general characteristics of dysphagia as a result of a partial glossectomy and radiotherapy when formulating a therapy plan. **When planning intervention the therapist can start by identifying the changes to the swallowing mechanism that are causing the swallowing problem.This will be done in both your clincial and instrumental assessment. These changes are often caused by surgery and postoperative radiotherapy and can significantly alter the swallowing mechanism (this are mentioned in my section so you could take them out).**


 * Prolonged oral preparatory time
 * slowed oral transit time
 * increased oral residue
 * increased pharyngeal residue
 * **14,15,16,17 (what is this?)**

The greater the amount of tissue that is resected the worse the swallowing functions tends to be, ( Groher & Crary, 2010). If the resection involves the tongue base, the risk of aspiration is significantly increased (Pauloski,2008). There are numerous methods of reconstruction available and the nature of reconstruction can also have an effect on the recovery of the swallowing mechanism. **However, because the extent of the reconstruction is often dependant on the extent and severity of the resection itself, it is often difficult to determine how much of an impact the reconstruction will have on the swallowing mechanism, ( Pauloski B.R., Rademaker, A.W., Logemann ,J.a et al. ,(2004). (I don't understand this sentence).**

 Radiotherapy is quite often used in conjunction with surgery with this population primarily to control for residual cancer cells ( Pauloski, 2008). Quite often radiotherapy is concentrated on the lymph nodes to prevent the spread of the disease ( Groeher and Crary, 2010). While it is is an effective way of controlling the spread of the cancer, it can significantly damage tissue and result in numerous unpleasent side effects which include but are not limited to: nausea and vomiting, fatigue, mouth sores, painful swallowing, loss of appetite, hypothryroidism, fibrosis, xersostomia, thickened saliva, redness and skin irritation in the area treated, osteoradionecrosis of the mandible, reduced sense of taste, bone pain and dental problems, ( Groher & Crary, 2010; Pauloski, 2008 ;Jansma, J., Issinik, A., Spijkervet, F.K., 1992). Many studies have also shown that radiotherapy hinders the improvement of the swallowing mechanism **and studies have shown that patients who had did not have postoperative readiotherapy demonstrated a steady increase in improved swallow efficiency, while those who had had postoperative radiotherapy did not,( 8,88). (is this necessary as those who did not are not our population).**

Setting Goals. Ethical and Best Practice Principals