Rehabilitation Program

Head & Neck Surgery

 

 

Appointments

(650) 498-6000

Press Option 2, then Option 3

 

 

Head and neck cancers and their treatments may impact a patient’s ability to eat and/or communicate. Many patients will benefit from speech and swallowing therapy to either address or prevent problems with communication and swallowing. Our head and neck cancer team includes expert speech-language pathologists (SLP’s) with specialized interest in the management of communication and swallowing disorders associated with head and neck cancer.  Our goal is to preserve and optimize function and quality of life for all of our patients.

If you are diagnosed with head and neck cancer, you can expect to meet with a SLP before starting your treatment as well as during and after your treatment. Your comprehensive care plan will include evaluation of your current speech and swallowing function, education about changes you may experience during and after treatment, and a personalized therapy plan.

Speech & Swallowing Rehabilitation

 

 

Your Care Team

Heather Starmer, MA, CCC-SLP, BCS-S
Clinical Associate Professor
Director of Head and Neck Speech and Swallowing Rehabilitation at the Stanford Cancer Center

Jennifer Kizner, MEd, CCC-SLP, BCS-S
Clinical Specialist
 

 

Jocelen Hamilton, MA, CCC-SLP
Speech Pathologist III


 

Our experts have extensive experience evaluating and treating swallowing disorders, sometimes referred to as dysphagia.  Our speech-language pathologists use a number of tests to look at swallowing abilities. There are two primary tests we use to assess swallowing, video fluoroscopy and video endoscopy. Video fluoroscopy is a motion X-ray test where you will be given a variety of food consistencies mixed with barium, a white liquid that shows up clearly on an X-ray. The test measures swallowing ability from the mouth to the throat and to the esophagus if necessary. Video endoscopy is done using a small flexible endoscope that is passed through the nose to the throat. This allows us to look at the swallowing area from above.  We can then watch as you swallow different foods and liquids to see how they go through the throat.  These tests allow us to understand how your swallowing muscles are functioning so that we can customize your treatment plan.

 

 

Rehabilitation

Modified Barium Swallow

This fluoroscopic video demonstrates a strong and efficient swallow that clears the dark liquid contrast through the throat into the esophagus (food pipe).

Modified Barium Swallow

This fluoroscopic video demonstrates a swallow that lacks the strength to push the dark liquid contrast through the throat into the esophagus (food pipe).  As a result, the contrast is seen to drip into the airway leading to aspiration.

Fiberoptic Endoscopic Evaluation of Swallowing

This endoscopic evaluation demonstrates assessment of airway and swallowing following a supracricoid partial laryngectomy.  This surgery involves removal of multiple structures of the voice box that typically offer airway protection during swallowing.  By using a compensatory swallowing strategy taught by the speech and swallowing therapist, this patient was able to resume a nearly normal diet.

The anatomy of the swallowing system.

At the Stanford Cancer Center we believe in preventative medicine. Research and clinical experience has shown us that swallowing problems can be common after treatment. We also know that therapy during treatment reduces the chance of swallowing problems. Keeping your swallowing muscles strong and active during radiation therapy is the best way to ensure they continue to work for years to come.  Strategies to rehabilitate swallowing function after treatment may include exercises that strengthen muscles or improve coordination, changes in posture while swallowing, or special swallowing techniques to make the food and liquid go down easier and safely. In some cases we will suggest specialty-designed utensils or drinking cups. Changes in food consistencies are sometimes suggested for safety or ease of swallowing.

Normal Swallowing

In the first stage of swallowing, the tongue pushes the food and liquid from the front to the back of the mouth. The lips must stay closed to prevent the food and liquid from spilling out of the front of the mouth. The cheek muscles must maintain tone so that the food and liquid does not spill into the space between the gums/teeth and the cheek.

In the next phase of swallowing, the muscles of the upper throat and soft palate come together to prevent food and liquid from going up the nose. As the food and liquid enters the throat, the airway closes up to prevent food and liquid from entering the windpipe and lungs.

Towards the end of the swallow the muscles of the back of the tongue and throat come together to push the food out of the throat and into the food pipe (esophagus). The muscle at the top of the esophagus relaxes to allow the food and liquid through.

Once the food and liquid is fully within the esophagus, the airway opens back up and all muscles return to their resting position. The muscles of the esophagus then strip the food and liquid from the top of the esophagus into the stomach.

What is Dysphagia?

Dysphagia refers to difficulty in swallowing.  Some symptoms of dysphagia include a sense of food/liquid getting caught in the mouth or throat, coughing/choking like things are going down the “wrong pipe”, difficulty chewing, and/or longer time needed to eat/drink.  Dysphagia can lead to other problems like weight loss or pneumonia from food/liquids entering the lungs.  Head and neck cancer and the treatments use to eliminate cancer are known risk factors for dysphagia.  The speech language pathologist can provide preventative and rehabilitative intervention for dysphagia.

What is Trismus?

Trismus occurs when a person has difficulty opening their mouth fully.  Trismus can lead to difficulty with eating, dental care, and speech.  Trismus often gets worse over time if not treated.  Surgery and radiation to the head and neck region are known risk factors for trismus.  Trismus prevention is an important part of the care provided by the speech language pathology team.



 

 

Head & Neck Surgery