142 Chapter 7
Robert had aspirated the purée even with the cuff inf lated. Several tests were conducted using the
blue dye while adjusting the pressure and placement of the tracheal cuff. Each time, dye penetrated
Robert’s lungs.
Robert returned to the acute wing of the hospital, where his trachea was examined
endoscopically. The surgeon discovered that he had a fistula (hole) in the trachea that allowed
puréed food and liquid into the air passageway. Apparently, the fistula was so large that no tracheal
cuff placement or adjustment of pressure could stop the infiltration. The fistula was surgically
repaired, and an NG tube was inserted while it healed. Thanks to the blue dye, the fistula had been
discovered and Robert no longer suffered from recurrent aspiration pneumonia. Eventually, he was
discharged from the rehabilitation center and received dysarthria therapy at the university speech
and hearing clinic. Two years later, he suffered a fatal asthma attack.
Case Study 7-4: Dysphagia Associated With
Partial Glossectomy in a 31- Year- Old Man
Kevin started smoking when he was 14 years old. He and his friend smoked two or three
cigarettes while waiting for the school bus, and their parents never suspected that this was the
reason for their leaving early for school. After graduation, Kevin took a job as a farm hand and
began using chewing tobacco. Like baseball players of old, he chewed chopped tobacco and spit
it onto the ground. He also liked to place a pinch of finely ground tobacco between his lower lip
and gum. By the time Kevin was in his 30s, he was addicted to nicotine. Also an alcoholic, Kevin
learned in Alcoholics Anonymous meetings that he had an addictive personality. It seemed he
could not break pleas ur able habits, and he used tobacco to excess. He loved the nicotine rush.
Kevin lived in a small mobile home provided by his employer. He spent days on the farm
plowing fields, baling hay, moving irrigation pipes, and harvesting wheat. Kevin was a hard
worker and a good farm hand. He was also a chain smoker, usually lighting a new cigarette with
an old one. In the eve nings he chewed tobacco, and just before going to sleep, he put a pinch of
the finely ground substance between his lower lip and gum. One day, he went to the dentist with a
toothache and was told to see an ear, nose, and throat specialist. Kevin disliked going to doctors,
but he followed instructions. The specialist performed several biopsies and told Kevin that he had
oral cancer. Kevin was devastated; he had always denied the risk. He thought cancer was for older
persons who had used tobacco for many years. That eve ning, he stopped using tobacco forever.
Kevin was admitted to the hospital and had several surgeries to remove the cancerous tumors.
About one third of his tongue was surgically removed— a partial glossectomy. Part of his lower jaw
and neck tissue were also excised to stop the deadly disease from spreading. Later, he underwent
radiation therapy. The surgeries and therapy took about 6 months, and a major complication was
difficulty swallowing. A tube was placed in his stomach, and five times a day Kevin poured a liquid
into it with all the vitamins, minerals, and nutrients he needed. When the doctor believed the
irradiated tissue and surgeries had healed and the soreness had subsided, he ordered a swallowing
evaluation. It had been months since Kevin had taken food or liquid orally, and the only tasteful
substance to enter his mouth was the lemon- f lavored swabs he used to clean and moisten it.