Lazarus C L
Department of Communication Sciences and Disorders, Swallowing Center, Northwestern University Medical School, Chicago, Illinois 60611, USA.
Semin Speech Lang. 2000;21(4):293-309. doi: 10.1055/s-2000-8383.
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.
本文介绍了头颈癌患者管理的最佳护理模式。讨论内容包括头颈癌多学科团队如何对头颈癌患者的治疗做出决策，以及言语病理学家作为团队一员的作用。具体涉及的问题有言语病理学家如何成为团队成员、提供术前干预，以及实施吞咽的临床和仪器评估及吞咽治疗。描述了头颈癌的治疗类型，包括手术治疗和器官保留治疗（放疗联合或不联合化疗）。描述了手术类型，包括手术切除和手术重建，并讨论了切除和重建对吞咽的影响。回顾了部分喉切除术、全喉切除术、部分咽切除术和口腔癌患者吞咽障碍的管理，以及腭托的使用和言语病理学家在腭托协同构建及吞咽后续管理中的作用。讨论了放疗和化疗治疗的类型及其副作用，以及这些治疗后出现的特定类型吞咽问题和该人群吞咽的管理。还介绍了最佳护理模式，包括针对不同头颈癌人群吞咽管理的时机和持续时间。
