The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute

SLP Case: Mr. A Elizabeth Lucarelli, MS CCC-SLP Speech-Language Pathologist James ENT - Head & Neck Oncology

Dysphagia is difficulty eating or swallowing

It can occur at one phase of the swallow, a combination of phases, or all phases

This difficulty can be related to:

Bolus clearance

Airway protection

In H&N cancer, can also be related to structural changes

Presence of mass

Surgical reconstruction

Radiation changes (fibrosis, lymphedema, xerostomia)

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Dysphagia

Occurs in 48-75% of head and neck cancer patients

Can result from surgery, XRT, or both Mild - may only result in cosmetic changes Severe - can impact speech, swallowing,

breathing, and vision

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Lymphedema

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63 y.o male with history of SCC of supraglottic larynx, diagnosed in 2009

Sept 2009: supraglottic laryngectomy, L modified radical neck dissection with L vagus nerve sacrifice

Post-op chemoXRT completed Dec 2009

July 2013: R radical neck dissection, resection of R parapharyngeal space tumor, resection of R external carotid, Levator scapula myofascial peddled flap

August 2013: PEG placed

Post-op chemoXRT completed Oct 2013

Mr. A

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Shiley #8 CFS trach Does not use/tolerate PMSV consistently Significant facial and neck lymphedema Lives 2 hours away Works part-time Highly motivated, very compliant

Mr. A

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Patient’s Report

No dietary restriction - on a regular diet with thin liquids

Takes medication via PEG

Having increased difficulty swallowing

Noting food/liquid coming out of his trach more often

No weight loss

No pneumonia or respiratory complaints

Tightness/discomfort in neck and face

Before treatment

Baseline MBS (10/16/14) revealed moderate-severe oropharyngeal dysphagia; significant internal lymphedema

Poor bolus clearance

Aspiration of all consistencies

Recommendations:

Dysphagia Advanced diet + thin liquids

Meds via PEG

Manual occlusion of trach + super supraglottic swallow maneuver

Initial PT eval: R face 91.5 cm; L face 94.5 cm

Therapy

Participated in lymphedema therapy with PT (+ home program) every 2 weeks from 10/16/14 - 1/22/15

Participated in swallowing therapy with SLP (+ home

program) every 2 weeks from 10/16/14 - 12/19/14

After Therapy

PT measurements: R 89.8 cm (-1.9); L 92.5 cm (-2) Repeat MBS (12/19/14) again revealed moderate-severe

oropharyngeal dysphagia; significant internal lymphedema Poor bolus clearance, +aspiration No change in recommendations

Conclusions

Moderate improvement in external lymphedema No observable change in internal lymphedema Limited objective change in swallow function Aspiration reduced but not eliminated

Mr. A endorses dramatic improvement in swallowing, breathing, sleep, and quality of life

Questions? Comments?

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