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Support services

Patients who have had surgery to treat oral cancer or surgery following a facial trauma may require specialist assessment and therapy to help them speak and swallow again.   Our speech and language therapy team, working alongside our oral and maxillofacial surgeons, provides this care. 

The level of rehabilitation will vary according to the extent of surgery a patient has received and the severity of their speech or swallowing problems. For example, patients who have a small cancerous growth removed from their tongue may only require two or three appointments with the speech and language therapist, while those who have experienced radical surgery to their mouths may require specialist assessment and possible long-term care for both speech and swallowing.

When the patient first meets with the speech and language therapist, either in the outpatient department or on the ward, an assessment of their speech and swallowing will take place.  The speech and language therapist will then provide advice and may recommend a course of therapy.  Alternatively, further investigations may be recommended.

Further investigations may include specialist tests to study how a patient swallows; (how food moves from the mouth down to the digestive system). 

Our speech and language therapy team use a number of specialist tests to help provide the right assessment.  These tests include:

• Videofluoroscopy of swallowing
• Fibreoptic endoscopic evaluation of swallowing (FEES)

Videofluoroscopy of swallowing

Videofluoroscopy is a special kind of x-ray that allows the speech and language therapist to investigate the structures and muscles used in swallowing. This test is undertaken in the barium suite on the 3^rd floor of the outpatients building at The Royal London Hospital.

Patients are asked to sit or stand in front of an x-ray machine and are given liquid barium during the videofluoroscopy, this is given as a drink followed by small amounts of barium coated foods (mainly yoghurt, banana and bread).  As the patient swallows the drink and eats this food an x-ray recording of how he/she swallows is made.  During the test, patients may be asked to put their heads in different positions or use different swallowing techniques to see if one swallowing technique works better than the other.  The speech and language therapist will then review the recording to decide on the best follow-up therapy.

Fibreoptic endoscopic evaluation of swallowing (FEES)

Fibreoptic endoscopic evaluation of swallowing (FEES) is a test which uses a small flexible fibreoptic endoscope.  A tiny camera (endoscope) is passed through the patient’s nose over the back of the mouth to a position slightly above the voice box. From this position the speech and language therapist can see exactly how well the patient is swallowing. 

In order to make the patient more comfortable, the inside of the nose is coated with numbing gel before the tiny camera is inserted.  Patients are then given foods or liquids that are tinted with food dye so that the speech and language therapist can see how the food is eaten, swallowed and where it goes.  This test allows for a detailed assessment which assists the speech and language therapist determine when the patient is safe to start eating and what should be eaten.

After the tests – swallowing and communication

Swallowing
After the tests and detailed discussions with the patient and family members, our team will have enough information to decide when the patient can start eating, the easiest and safest foods to eat, and any treatment techniques that will improve safety during eating.  Some tests may be repeated to see how the patient is progressing and to decide whether any changes to the treatment plan are needed.

If required, some patients will be shown a series of exercises designed to get their mouth and neck muscles working properly again.  Patients are carefully monitored and those that live within the hospital’s catchment area will have return visits and one-to-one appointments with the speech and language therapist.  There are no hard and fast rules about the recovery period; some patients may require rehabilitation for a few months while others require many years.

Communication

If a patient’s speech has been severely impaired as result of orofacial cancer or accident or trauma to the mouth, the speech and language therapist will make appropriate recommendations and guide patients through the path of learning to speak again. 

Sometimes the patient’s condition and subsequent surgery results in certain mouth nerves being damaged or destroyed – while a good quality of life can be achieved, sadly their speech may never return to normal.  In such cases, the speech and language therapist will do everything possible to re-teach the patient how to make the most of their speech ability.  This normally involves one-to-one sessions with the speech and language therapist who provides the patient with specific facial exercises and advice on how to produce certain sounds. 

If the ability to speak never returns,  then the speech and language therapist will review and provide the best possible alternative communication method which may include picture boards or special electronic communication devices.