Evaluation and management of oropharyngeal Dysphagia in head and neck cancer.
BACKGROUND
Dysphagia is a common symptom of head and neck cancer or sequelae of its management. Swallowing disorders related to head and neck cancer are often predictable, depending on the structures or treatment modality involved. Dysphagia can profoundly affect posttreatment recovery as it may contribute to aspiration pneumonia, dehydration, malnutrition, poor wound healing, and reduced tolerance to medical treatments.


METHODS
The author reviewed the normal anatomy and physiology of swallowing and contrasted it with the commonly identified swallowing deficits related to head and neck cancer management. Evaluation methods and treatment strategies that can be used to successfully manage the physical and psychosocial effects of dysphagia are also reviewed.


RESULTS
Evaluation of dysphagia by the speech pathologist can be achieved with instrumental and noninstrumental methods. Once accurate identification of the deficits is completed, a range of treatment strategies can be applied that may return patients to safe oral intake, improve nutritional status, and enhance quality of life.


CONCLUSIONS
To improve safety of oral intake, normalize nutritional status, reduce complications of cancer treatment and enhance quality of life, accurate identification of swallowing disorders and efficient management of dysphagia symptoms must be achieved in an interdisciplinary team environment.
Gaziano
Joy E
JE
Speech Pathology Department, H. Lee Moffitt Cancer Center Research Institute, Tampa, Florida 33612, USA. gazianje@moffitt.usf.edu
D001676:Biofeedback, Psychology; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000523:psychology / Q000628:therapy*; D003679:Deglutition / Q000187:drug effects / Q000502:physiology / Q000528:radiation effects; D003680:Deglutition Disorders / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D005247:Feeding Behavior; D006258:Head and Neck Neoplasms / Q000150:complications / Q000523:psychology / Q000628:therapy*; D006801:Humans; D010353:Patient Education as Topic; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011187:Posture; D011788:Quality of Life; D016896:Treatment Outcome