How might radiotherapy for head and neck cancer affect VFSS findings and therapy planning?

• A. Radiation improves tissue elasticity, leading to faster swallow.
• B. Radiation has no impact on swallow mechanics and VFSS.
• C. Radiation causes only temporary coughing with meals and no residue.
• D. Radiation can cause mucositis, fibrosis, reduced tissue compliance, and impaired laryngeal elevation; expect slower swallow, increased residue, and plan therapy with safe textures and targeted exercises.

Answer: (D)

Radiotherapy to the head and neck often induces mucosal injury and fibrotic change, which reduce tissue compliance and compromise hyolaryngeal movement. On VFSS these effects show up as a slower, less efficient swallow with reduced hyolaryngeal elevation and pharyngeal constriction, leading to more residue in the valleculae and pyriform sinuses and a higher risk of airway entry. Because these changes persist or progress, therapy planning focuses on keeping swallowing safe while promoting function. This means modifying textures to reduce bolus risk, using compensatory strategies (such as a chin-down or head turn to redirect flow), and implementing targeted exercises to enhance propulsion and laryngeal elevation (for example, Mendelsohn maneuver, Shaker/forward head-lift, and effortful swallow). Regular follow-up VFSS helps tailor the plan as the tissue response evolves.