Question
I evaluated a patient who recently had a partial glossectomy with a tongue flap replacement. The patient is currently unable to move his tongue. Do you have any suggestions for therapeutic techniques to restore lingual movement?
Answer
A partial glossectomy can mean a variety of dissections, i.e. a lateral wedge, unilateral complete, with or without the tonsile fossia involved. Has the remaining tongue been used to cover a floor of mouth excision? In any case, tongue movement for mastication and swallow and tongue movement for articulation need to be addressed. In addition, the patient should be taught self examination to insure that he/she is not damaging the remainder of the tongue while chewing. REMEMBER; the remaining Unilateral tongue portion will deviate to the affected side.
Treatment. non-movement in the initial weeks is to be expected. This may be due in part to the patient relearning volitional control. First session/week exercises. All exercises are five repetitions.
Mandible opening; open mouth as far as possible. This is good exercise for stimulation of tongue base.
With a tongue blade; push non-affected side of tongue against blade for count of three and relax.
Attempt to lick alvelor ridge, left to right, then right to left.
Attempt to lick lip, left to right , then right to lef.
Attempt to push non-affected cheek out and hold for count of three.
With teeth together and lips closed, attempt to push tongue forward and hold for count of three.
Repeat #6 but push tongue to roof of mouth for count of three.
For prevention of saliva pooling, pucker lips and do a strong suck-back and swallow.
Any attempted articulation is good stimulation for tongue movement... I have a list of non-glossal sentences and then move into some that have glossal movement.
i.e. "Why buy ham mom", "May I have more" and move to, "Head light" "small hotdog"
If the patient is not a risk for aspiration, any swallowing activity is good stimulation for tongue movement. Start with a consistency that is easy to manage such as pudding or honey and move to a thinner consistency.
All of the above should be attempted even if the patient insists there is no movement. Re-access each week. Usually as the edema from surgery subsides, glossal movement increases.
Dennis Fuller, Ph.D., is an Associate Professor in the Departments of Communication Sciences and Disorders and Otolaryngology, Saint Louis University. He publishes in the areas of Post Surgical Communication and Swallowing disorders. He is a current Legislative Council representative from Missouri to ASHA.
Dennis Fuller, Ph.D
Related Courses
1https://www.speechpathology.com/slp-ceus/course/ripple-effect-stuttering-community-based-9217The Ripple Effect of Stuttering: A Community-Based ApproachThis is Part 2 of a four-part series. The stuttering experience has a ripple effect that extends far beyond the child who stutters. Parents, teachers, peers, and others must possess both knowledge and skills to best support children who stutter. This course will highlight new clinical tools and resources to provide a community-based treatment approach for stuttering. (Part 1 - Course 9278, Part 3 - Course 9301, Part 4 - Course 9304)auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlySpeechPathology.comwww.speechpathology.comThe Ripple Effect of Stuttering: A Community-Based ApproachThis is Part 2 of a four-part series. The stuttering experience has a ripple effect that extends far beyond the child who stutters. Parents, teachers, peers, and others must possess both knowledge and skills to best support children who stutter. This course will highlight new clinical tools and resources to provide a community-based treatment approach for stuttering. (Part 1 - Course 9278, Part 3 - Course 9301, Part 4 - Course 9304)9217OnlinePT120M
This is Part 2 of a four-part series. The stuttering experience has a ripple effect that extends far beyond the child who stutters. Parents, teachers, peers, and others must possess both knowledge and skills to best support children who stutter. This course will highlight new clinical tools and resources to provide a community-based treatment approach for stuttering. (Part 1 - Course 9278, Part 3 - Course 9301, Part 4 - Course 9304)
2https://www.speechpathology.com/slp-ceus/course/20q-infection-control-strategies-for-972920Q: Infection Control Strategies for SLPsSpeech-language pathologists are expected by policy authorities to apply appropriate measures to protect patients, co-workers and themselves in clinical situations that may expose individuals to infectious microbes. This article provides practical guidelines for implementing infection control principles within the context of the COVID-19 pandemic, including discussion of personal protective equipment (PPE) and disinfecting and cleaning products.textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlySpeechPathology.comwww.speechpathology.com20Q: Infection Control Strategies for SLPsSpeech-language pathologists are expected by policy authorities to apply appropriate measures to protect patients, co-workers and themselves in clinical situations that may expose individuals to infectious microbes. This article provides practical guidelines for implementing infection control principles within the context of the COVID-19 pandemic, including discussion of personal protective equipment (PPE) and disinfecting and cleaning products.9729OnlinePT60M
Speech-language pathologists are expected by policy authorities to apply appropriate measures to protect patients, co-workers and themselves in clinical situations that may expose individuals to infectious microbes. This article provides practical guidelines for implementing infection control principles within the context of the COVID-19 pandemic, including discussion of personal protective equipment (PPE) and disinfecting and cleaning products.
3https://www.speechpathology.com/slp-ceus/course/thickened-liquids-in-clinical-practice-10497Thickened Liquids in Clinical Practice: The Plot “Thickens”Clinicians who utilize thickened liquids in their clinical practice are aware of their benefits, but what about the risks and contraindications? Advantages and disadvantages of thickened liquids are reviewed in this course with a focus on clinical outcomes, including impacts on medication administration, lung health, and hydration. Product types are evaluated to facilitate appropriate choices for individual clients.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlySpeechPathology.comwww.speechpathology.comThickened Liquids in Clinical Practice: The Plot “Thickens”Clinicians who utilize thickened liquids in their clinical practice are aware of their benefits, but what about the risks and contraindications? Advantages and disadvantages of thickened liquids are reviewed in this course with a focus on clinical outcomes, including impacts on medication administration, lung health, and hydration. Product types are evaluated to facilitate appropriate choices for individual clients.10497OnlinePT60M
Clinicians who utilize thickened liquids in their clinical practice are aware of their benefits, but what about the risks and contraindications? Advantages and disadvantages of thickened liquids are reviewed in this course with a focus on clinical outcomes, including impacts on medication administration, lung health, and hydration. Product types are evaluated to facilitate appropriate choices for individual clients.
4https://www.speechpathology.com/slp-ceus/course/slp-in-nicu-overview-11267SLP in the NICU: An OverviewThis course provides an introductory overview of Speech-Language Pathology services in the Neonatal Intensive Care Unit (NICU), including the unique environment, the SLP’s role, and key components of neonatal care. Topics include cue-based and supportive feeding strategies, instrumental assessments, and approaches for empowering and supporting parents and caregivers.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlySpeechPathology.comwww.speechpathology.comSLP in the NICU: An OverviewThis course provides an introductory overview of Speech-Language Pathology services in the Neonatal Intensive Care Unit (NICU), including the unique environment, the SLP’s role, and key components of neonatal care. Topics include cue-based and supportive feeding strategies, instrumental assessments, and approaches for empowering and supporting parents and caregivers.11267OnlinePT60M
This course provides an introductory overview of Speech-Language Pathology services in the Neonatal Intensive Care Unit (NICU), including the unique environment, the SLP’s role, and key components of neonatal care. Topics include cue-based and supportive feeding strategies, instrumental assessments, and approaches for empowering and supporting parents and caregivers.
5https://www.speechpathology.com/slp-ceus/course/dysphagia-in-neurodegenerative-disease-9732Dysphagia in Neurodegenerative DiseaseDysphagia is common in individuals with amyotrophic lateral sclerosis (ALS) and Parkinson’s disease. This course discusses the underlying pathophysiology and appropriate treatment programs for each disease, as well as use of alternate methods of nutrition/hydration.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlySpeechPathology.comwww.speechpathology.comDysphagia in Neurodegenerative DiseaseDysphagia is common in individuals with amyotrophic lateral sclerosis (ALS) and Parkinson’s disease. This course discusses the underlying pathophysiology and appropriate treatment programs for each disease, as well as use of alternate methods of nutrition/hydration.9732OnlinePT60M
Dysphagia is common in individuals with amyotrophic lateral sclerosis (ALS) and Parkinson’s disease. This course discusses the underlying pathophysiology and appropriate treatment programs for each disease, as well as use of alternate methods of nutrition/hydration.
