Planning+Treatment

= Planning Treatment = 

One very important consideration for the swallowing specialist is when to start the treatment plan. There is varied literature on this. Some studies recommend starting therapy as soon as possible as the outcome would be better for the patient (Denk,D.M., Kaider, A., 1997 ; Zuydam A., Rogers S., Bown, et al., 2000). Other studies advocate intervention strategies be implemented before or during cancer treatment as this could reduce the severity of the dysphagia after cancer treatment (Kulbersh ,B.D., Rosenthal, E.L., McGrew , B.M et al., 2006).

The SLT must also take into account other factors that may impact on when treatment can commence. For example, the patient may have been fitted with an artificial airway,which can include tarcheostomy tubes. This is generally performed as an emergency procedure to protect the airway, often during surgery. The decision to extubate, decannulate or reduce the need of an arftificial aid is made when the indicators for support are no longer present. Also, patients are often PEG fed during radiotherapy to maintain nutrition and hydration, and sometimes after treatment until oral feeding and drinking can be reestablished (Groher & Crary, 2010).

Reconstructive processes after a partial glossectomy can have varying degrees of impact on the swalowing mechanim.Primary closure,( surgical closure of the edges of the resection),may result in some restriction in tongue movement (Pauloski,2008). Other patients with reconstructed skin grafts, (transplantation of another layer of skin from another anatomical site to the surgical resection), have superior tongue mobility then those compared with primary resections (Pauloski,2008).Patients reconstructed with pedicled flaps, (flaps of tissue lifted from a donar site and migrated into the surgical defte with a pedicle of stem of tissue), (Pauloski,2008) ,have shown impaired tongue mobilty, excessively long oral transit times ,increased oral residue and reduced oropharyngeal swallow efficiency (Logemann, Pauloski, Rademaker, et al.,2003).

These factors can complicate the optimum time to commence treatment. It is very important to realise that the decision about when to start treatment is not a decision that the SLT can make alone and it is imperative that she/ he must colaborate with the multidisiplinary team (MDT), (refer to our section on team approach).

Possible Complications and Side Effects of Treatments