Eating and drinking after head and neck cancer treatment

If you have eating problems, you will usually be supported by a speech and language therapist (SLT). They can teach you exercises and techniques to help you chew and swallow.

You may also see a dietitian who can advise you on how to increase the nutrients and calories in your diet. They may give you high-calorie supplement drinks if you have lost weight. Supplement drinks are high in sugar and are usually only used for a short period of time. This is to avoid long-term damage to teeth and jaws.

It can take a lot of effort and patience to overcome eating difficulties. If you have found eating difficult for a while, you may no longer associate food with pleasure. Taste changes may reduce your desire for food and affect your appetite.

Talk to your SLT or dietician if you feel this way. They may use different coping techniques, such as mindful eating, to help you enjoy food again. These techniques can help you to feel more relaxed at meal times and find things about eating you can still enjoy.

We have information about what to eat to increase your weight after cancer treatment.

Surgery for mouth cancer can affect chewing and the mouth stage of swallowing. If only a small amount of tissue is removed, the effect on chewing may be small. You will probably adjust quite quickly. If a lot of tissue is removed, or if some or all of the tongue or soft palate is removed, you may have longer-lasting changes.

If you had teeth removed, your ability to grind food while chewing may change. This can also happen if you have dentures that no longer fit.

Surgery or radiotherapy can affect the muscles and nerves that control the lips, tongue or other parts of your mouth. This may make it difficult to control food and fluid in your mouth or sense where food is in your mouth.

Jaw stiffness or a dry mouth also cause difficulties with chewing and swallowing.

Surgery to the voicebox (larynx) mainly affects the throat stage of swallowing. Swelling in the throat caused by a build-up of fluid in the tissues (lymphoedema) can also affect swallowing.

Radiotherapy may make muscles and tissues in the throat and gullet weaker and less stretchy. This can make it harder to swallow some foods or cause certain foods to stick in the throat. If nerves that control the muscles in the gullet are affected, they may be less able to move food downwards.

The upper part of the gullet may become narrower after radiotherapy. Any nerve damage may make it harder for you to know whether there is food in the gullet.

Problems with swallowing can cause food or drink to go down the wrong way into the windpipe. This is called aspiration. It can cause choking and may lead to chest infections.

Sometimes swallowing problems develop months or years after radiotherapy. This can happen if scar tissue in the throat makes the swallowing muscles tight and hard. This is called fibrosis.

You may be able to have treatment to help with chewing. The type of treatment you have depends on what is causing the problem. Problems could be caused by:

• a change in the shape of your mouth
• tooth loss
• jaw stiffness
• dry mouth
• loss of sensation.

It is important you are assessed by either a surgeon, a restorative dentist or a speech and language therapist (SLT).

Changes to your bite or to the tissues inside your mouth may affect your ability to eat or speak. A restorative dental consultant (restorative dentist) may be able to help.

Obturators

After surgery to the roof of the mouth (maxilla), some people have an opening between the roof of the mouth and the nose. You may be able to have restorative surgery to help with this.

A restorative dentist can cover the opening with a special type of dental plate called an obturator. This stops food, fluid and air passing between the nose and mouth. Some obturators have a speech bubble at the back to help with speaking.

If you need an obturator, you will usually be fitted with a surgical obturator at the time of your cancer surgery. It is replaced with a temporary obturator a few weeks after your operation. This is because as the tissues in the mouth heal after surgery. They get smaller until they reach their final size and shape. This can take 6 months or longer.

Once your mouth has healed into its final shape, the restorative dentist will make you a longer-term obturator. Your mouth will continue to change shape over the years. Your obturator will need replacing when it starts to feel uncomfortable.

You will have regular appointments to check the obturator fits well and feels comfortable.

It is important to let your restorative dentist know if you have any problems with how well the obturator fits between these appointments. As the tissues in your mouth settle, they may need to adjust the fit from time to time.

Dental rehabilitation

If you had any teeth removed before surgery or radiotherapy, the restorative dental consultant will assess you for follow up dental care. You may need to be managed for gum disease. Or you may need removable dentures, bridges or implants. This will depend on the needs of your mouth and the type of cancer treatment you have had.

Your SLT will assess the problems you have with your chewing. They may arrange for you to have tests to help find out the best way to treat any problems.

They may give you exercises to strengthen your lips, tongue and other muscles in your mouth. There are also exercises you can do to help stimulate parts of the mouth that have lost sensation.

Your SLT may give you chewing aids such as Chewy Tubes^® to help you practise biting and chewing. Or they may give you spoon-shaped devices such as Ora-Light^® to exercise the lips and tongue.

They may also advise you to eat soft, moist foods. Depending on what is causing the chewing difficulties, you may find it easier to chew larger or smaller amounts of food. Your dietician can also give you more advice on this.

Radiotherapy to your mouth can affect your sense of taste. A lack of saliva can also affect your taste buds. Some treatments can change your sense of smell, which can affect taste.

Most foods may taste the same or you may dislike the taste of certain foods. Some people can taste the first few bites of food and then find the taste gets weaker. These changes can lower your desire for food and affect your appetite.

Usually, your sense of taste gradually improves after treatment ends. But sometimes it can take a year or more. If you have taste changes, tell your doctor, dietitian or specialist nurse. They can offer advice and support.

Read more about our tips for coping with taste changes.

Many social activities involve eating and drinking. If you have difficulty chewing or swallowing, you may feel anxious or unsure about eating in front of other people.

For more support and advice, you can visit our head and neck cancer forum to talk with people who have been affected by head and neck cancer, share your experience, and ask an expert your questions.