Management of swallowing disorders in head and neck cancer patients: optimal patterns of care.

This article presents optimal patterns of care for management of head and neck cancer patients. Discussion includes how the head and neck cancer multidisciplinary team makes decisions regarding treatment for head and neck cancer patients and the role of the speech pathologist as part of the team. Specifically addressed issues are how speech pathologists can become team members, provide pretreatment intervention, and implement clinical and instrumental assessment of swallowing and swallowing treatment. Types of treatments for head and neck cancer are described, including surgical and organ preservation (radiotherapy with or without chemotherapy). Types of surgeries are described, including surgical resection and surgical reconstruction with discussion of the effects of both resection and reconstruction on swallowing. Management of swallowing disorders in the partial laryngectomy, total laryngectomy, partial pharyngectomy, and oral cancer patient are reviewed, as well as use of palatal prostheses and the speech pathologist's role in collaborative construction of the prosthesis and follow-up management of swallowing. Types of radiotherapy and chemotherapy treatments and their side effects are discussed as are specific types of swallowing problems seen after these therapies and management of swallowing in this population. Optimal care patterns, including timing and duration of swallow management specific to various head and neck cancer populations, are presented.