Swallowing problems in patients with head and neck cancer:

The restoration of swallowing skills in head and neck cancer surgery patients demands a two-pronged approach: thorough and systematic evaluation and simple, fundamental treatments. Therapists should begin with an assessment of their own biases and their knowledge of head and neck cancer and its surgeries. The patients themselves should be evaluated presurgically-to determine food preferences, other medical conditions, nutritional status, and current swallowing abilities, and postsurgically-to assess facial symmetry, oral mobility and strength, saliva management, aspiration risk, and altered swallowing skills. Treatment approaches should generally be basic, stressing oral exercises, positioning techniques, the use of feeding aids, and teaching the supraglottic swallow. Attention to special considerations, like problems with cuffed tracheostomies and the controversies over using variable food consistencies, will refine the treatment.