Head and Neck Cancer

1
Head and Neck Cancer

• Assessment and Treatment

2
Duel Responsibilities

• Speech
• Articulation
• Reconstruction
• Compensatory skills
• Resonance
• Reconstruction
• Prosthetics
• Rehabilitation
• Short and Long term

• Swallowing
• Reconstruction
• Diet modifications
• Positional changes
• Lymphedema

3
Pre Operative Conference

• Why is it a good idea? NPSG, site.
• When it should happen.
• Who should attend.
• What should be discussed, timelines, xrt.
• How it should be documented.
• Language used?
• Signed by all present.

4
Speech Assessment-PreOp

• Oral motor exam is essential.
• Assess current structures, ROM.
• Inform the pt of findings and give some
  prognostic information regarding post op changes,
  etc.
• Discuss edema, timelines, commitment to therapy,
  preventive tx (trismus), etc.

5
Speech Assessment-Post Operation

• Oral motor exam is essential.
• Reconstruction-flaps, muscles, Titanium.
• Talk to surgeon and make sure you know what was
  done.
• Movement-muscle bundles, glides.
• Assess edema, too early?
• Assess pain.
• Assess diet.

6
Articulation-Site of Lesion

• Lips
• Hard palate
• Soft palate
• Floor of mouth
• Tongue
• Tip
• Blade
• Dorsum
• Base

• Tonsilar pillars
• Epiglottis
• Supraglottis
• Larynx
• Composite

7
Articulation-Lips

• Suture line gives info about sensation.
• Movement of the obicularis oris to pucker, smile,
  lift, and shape.
• Contact of teeth, if present, to lips.
• Treatment plan Use a mirror and teach
  open-close for /p,b,m,/ pucker-smile for vowel
  shaping and /w/, teeth contact for /f,v/. They
  tend to reduce movement of if edema is/was
  present, they need to exaggerate the effort.

8
Articulation-Hard Palate

• Check reconstruction for vaulting, level
  discrepancies, open fistulas.
• Treatment plan If prosthetics are planned, see
  what areas can be augmented and work with the
  prosthodontist. May need to drop the palate for
  better contact with tongue. Teach compensatory
  tongue contact with best side for /t,d,n,ch,j/.

9
Articulation-Soft Palate

• Check reconstruction for bulk and movement.
• Nasendoscopy will be essential.
• Treatment plan Based on results of NE, surgical
  vs. prosthetic or both. Use traditional VP
  exercises direct oral vs nasal airstream, avoid
  co-artics, plug nares, etc. for pressure
  consonants, /f,v,s,z,th,sh/, and plosives.
• Easier than children with VP because they know
  what it sounds like and have a better ears for
  self-monitoring.

10
Articulation-Tongue

• Partial vs Total Glossectomy (tip vs blade).
• Evaluate the remaining structures for ROM,
  sliding, muscle bundles, etc.
• Evaluate distance from tongue to alveolar ridge
  and soft palate.
• Treatment plan Finding the best side, the best
  movement, best compensation, best contact.
  Increase contact strength. Increase approximation
  to vowels. Use prosthetics.

11
Articulation-Floor of Mouth

• Very common cancer.
• Extent of the surgery is important here.
• Removal of BOT.
• Tongue sutured to FOM.
• Jaw removed and replaced or reconstructed.
• Treatment plan Tongue ROM, increase contact
  with best side, strengthening.

12
Articulation-Oropharynx

• Tonsilar pillars-part of composite resection and
  reconstruction? Hard or Soft palate?
• Epiglottis-BOT involved? Restricted /k,g/
• Supraglottis-BOT involved? Speech spared.
• Treatment plan Depends on the structures
  involved and the extent of reconstruction.

13
Resonance

• Composite resections and reconstructions
  involving the hard and soft palate will affect
  resonance.
• Nasendoscopy to determine VP function and
  consultation with plastic surgeons or
  prosthodontist regarding closure choices.
• Treatment plan Obturators with augmentation and
  traditional VP exercises.

14
Speech/Artic/Voice-Larynx

• Writing
• Electrolarynx training
• Esophageal speech training
• Tracheoesophageal prosthesis-placement,
  management, troubleshooting.

15
Rehabilitation-Short Term

• The pt will adjust and compensate for speech
  spontaneously in the first two months.
• Despite the lack of structures, a reasonable
  amount of intelligibility is regained by all.
• Treatment plan Encourage continued verbal
  interaction and refine speech.

16
Rehabilitation-Long Term

• As swelling and the pts ability to communicate
  improve, the refinement continues for a few
  months with monthly maintenance sessions.

17
Self-inflicted GSW to mouth.

• Can be viewed similarly to HNC patients due to
  the obliteration of structures and the
  compensatory skills needed to produce speech.
• Evaluate oral motor, talk to plastic surgeons and
  prosthodontists as indicated.
• Treatment plan Teach compensatory speech
  strategies related to the structures that are
  missing.