Mr. Smith hаd а T3N0M0 glоttic cаncer and underwent tоtal laryngectоmy with bilateral modified radical neck dissection 3 weeks ago. He never had preoperative radiation and there is no plan for postoperative radiation. He had a primary puncture during his surgery and currently has a 16 French catheter in his TEP which is being used for tubefeeding. He just saw ENT and the surgeons did a swallowing test in the clinic and have cleared him to eat and drink, pending your approval. The surgeons also have cleared him for removal of the catheter and placement of his first voice prosthesis. He comes to your clinic after his ENT appointment with his wife. His neck and lower face appear mildly edematous but his incisions appear well-healed. Both the patient and his wife seem anxious and are eager for him to begin to eat and talk. 1. Explain the steps you would take in terms of assessing his swallowing ability. How would you determine if it was safe for him to eat and drink? 2. Explain the steps you would take in fitting him with his first prosthesis. (You do not need to be specific about which prosthesis you would select) 3. Once you place the voice prosthesis, the patient is unable to achieve tracheoesophageal voicing with thumb occlusion of his stoma. Why might this be occurring? What steps would you take to troubleshoot during your clinic visit? 4. How would you counsel the patient and wife if voicig could not be acheived during the visit? What would you do or expect going forward? 5. What other educational needs might the patient or family member have at this point? What else do you want to teach or explain?
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