Importance+of+Direct+Therapy+procedures+before,+during+and+after+radiation+and+surgery

Direct therapy procedures are designed to change the swallowing physiology by altering specific components of the swallowing mechanism. They can include exercises to improve or increase muscle strength, range of motion and control. The reasons that surgery and its associated complications can contribute to dysphagia are obvious. The more tissue that are removed or reconstructed in the oral cavity can dramatically alter the swallowing mechanism. its important ( look up ferfor why it is important to exercise post surgery). THe potential side afects of radiation that may contribute to dysphagia are not as obvious.  Xerostomia is a side effect of treatment that persists for years and may worsen over time. Late radiation effects may include osteoradionecrosis (a condition where irradiated bone and surrounding tissues lose their reserve reparative capacity and start to degenerate ), trismus (lockjaw), reduced capillary flow, altered oral flora, dental caries, and altered taste sensation. The late effect of reduced blood supply to the muscle can result in fibrosis, reduced muscle size, and the need for replacement with collagen. This can dramatically affect swallowing years after treatment with a fixation of the hyolaryngeal complex, reduced tongue range of motion, reduced glottic closure, and cricopharyngeal relaxation, resulting in potential for aspiration. Specific swallowing exercises have been shown to reduce these effects and improve prognosis for oral intake. These include jaw range of motion, tongue base range of motion exercises, and effortful swallow exercises, tongue holding maneuver, Mendelsohn maneuver, and super supraglottic swallow. Patients are encouraged to practice these exercises daily during and after treatment since effects of radiation can occur long after treatment completion.