Friday, April 20, 2012

Neck Dissection After Effects

I am 4 years post chemo radiation for nasopharyngeal ca. 3 months ago I had recurrent cells in neck lymph. Radical rt side neck dissection done 8 weeks ago and back on frequent follow up. My swallowing post rad has never been good but now I have major swallowing problems, food gets stuck and causes bad coughing and choking. Also have horners syndrome in the rt eye. Speech therapist exercises don't seem to be helping should I persevere or are there any other options? Was wondering if the swelling was due to tubes during surgery or is this expected after neck dissection.

Dr. Califano replies...
Swallowing is a complex phenomenon. It is a highly sequenced set of muscle contractions, with each set of movements dependent on appropriate completion of the preceding movement and sensation of the movement of food and/or water at each step triggering the following step. In essence, it is a highly automatic but sequential action, much like the game of hopscotch. Similarly to hopscotch, if you nearly miss one step, the next few steps can be much more difficult, and the whole process breaks down, since with each missed movement it is much, much harder to recover.

It's very hard to comment on individual cases, but as best as one can tell from your history, you were having difficulty swallowing to begin with, and then underwent a neck dissection. To continue a hopscotch analogy, you were probably just barely completing the sequence, and then the pattern of skips and jumps was changed. This change includes muscle tethering/fibrosis, edema, and alteration in sensation and muscle function in the case of surgery.

We do know that neck dissection effects on swallowing are minimal in unradiated patients, but that when patients have undergone chemotherapy and radiation, a minority of patients will have noticeable worsening of swallowing function, particularly those with borderline function to begin with. The best option for treatment is to find a speech pathologist with experience in working with patients who have undergone treatment for head and neck cancer, and work with them patiently, as recovery of swallowing function can take many months, and may require optimization of nutrition, correction of any strictures or narrowing, and long term therapy. Resolution of edema can also take months to a year or so, so persistence with therapy is often worth the effort.

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