Oropharyngeal Health After Cancer What Every Laryngectomy Should

Oropharyngeal Health After Cancer: What Every Laryngectomy Should Know Katrina M. Jensen, M. A. , CCC-SLP Director, Medical Speech Pathology Privia Medical Group of North Texas Health Care, PLLC Otolaryngology & Facial Plastic Surgery Associates

Disclosures I am employed by Texas Health Care, PLLC as the Director of Medical Speech Pathology. I am a collaborative investigator with MD Anderson through the Cancer Prevention & Research Institute of Texas for which I receive a grant stipend. I serve as a clinical consultant for Medtronic, GI division for which I receive compensation.

Xerostomia: It’s More Than Just Dry Mouth Salivary flow/production may be adequate for deglutition Submandibular gland is frequently impacted by radiation treatment

Concerns Beyond Oral Comfort: Dental/Gingival Health Dysguesia Mucosal Integrity Aerodigestive Chemistry

Dental/Gingival Health Enzymatic function of saliva on “biofilm” Protects enamel from plaque; diminished tartar Dry gums=capillary death; gum retraction Increased sensitivity Increased caries, risk of tooth death Increased risk for mandibular infection

Dysguesia “Taste Buds” Nerve receptors on tongue surface Need moisture to stimulate Prolonged dryness linked to nerve damage Burning tongue Altered perception Disabled receptors

Mucosal Integrity Delicate surface tissue Thin cellular surface layer Saliva acts as surfactant/ “protector” Responsible for oropharyngeal proprioception Prone to infectious process without adequate surfactant

Aerodigestive Chemistry Saliva is nature’s lubricant The original “probiotic” Enzymatic breakdown of biofilm Bicarbonate effect Increased potential for acid reflux damage Less saliva translates to less bacteria yeast proliferation

Optimizing Oral Health Focus has been on oral comfort Need to marry comfort with chemistry Optimize natural saliva production Adequate hydration Gum Xyletol candy/lozenges

Optimizing Oral Health Dental Hygeine Bicarbonate rinse May be used as often as desired Helpful to use prior to meals to improve taste Keffir cultures Yogurt Avoid capsules

Optimizing Oral Health: Overnight Humidification Needs to be at bedside table Xylomelt Bicarbonate rinse at bedside Water at bedside

Optimizing Pharyngeal Health Yeast and Acid are two biggest culprits Pharyngeal irritation/damage Can extend throughout esophagus TEP implications Alkaline Water Dental Hygeine Active Yogurt cultures Minimize yeast products

THC Research Data 1 year study (2 nd year ongoing) 202 H&N patients (53 TL) (101 control) Oral Health Protocol Twice daily brushing 3 x/day bicarbonate rinse Alkaline water Nightly humidification Yeast Elimination 2 daily yogurt products

THC Research Data 101 H&N patients: 26 TL 74 reported excellent compliance (20 TL) 6 -7 days/week followed protocol 7 reported moderate compliance (1 TL) Missing 1 -2 elements 6 -7 days/week Excellent compliance 3 -5 days/week 20 patients with poor compliance (5 TL)

THC Research Data 81 patients with excellent or moderate compliance were compaired to controls: Oral comfort (Likert scale) Dental Caries Dysguesia Thrush infections Device lifetime(21 TL)

THC Research Data Oral Comfort (1 -5; 1=extreme discomfort/pain; 5=no issue) Baseline mean 2. 7 Program compliance mean 3. 5 Dental Caries Control: 322 Program Compliance: 108 Dysguesia (1 -5; 1=no taste; 5=normal) Baseline Mean: 3. 7 Program Compliance: 4. 4 Thrush Infections Control: 237 Program Compliance: 41 Device Lifetime (21 TL) Control: 114 days Program Compliance: 186 days

Translation: Optimized oropharyngeal health can serve to improve quality of life, may assist in preventing illness and reduce cost associated with care.

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