Eating and drinking changes after treatment

Chewing and swallowing involve your lips, teeth, tongue and the muscles in your mouth, jaw and throat working together in a coordinated way. Surgery or radiotherapy for head and neck cancer can affect one or more of these structures. This can cause problems with eating or drinking.

If you have difficulty chewing you may:

  • drool when eating
  • notice that food gets trapped in one side of your mouth
  • be more likely to bite your tongue or the inside of your cheeks.

Swallowing moves food to the back of the throat and then down the foodpipe. If any of the steps involved in swallowing goes wrong, food can get into the nose or go down the windpipe by mistake. Signs that you may have swallowing problems can include:

  • food coming down your nose
  • feeling that you have too much saliva
  • food sticking in your throat
  • choking or coughing when eating or drinking
  • a gurgly-sounding voice
  • repeated chest infections
  • weight loss.

What happens when you chew and swallow

Chewing prepares food in the mouth to make it easier to swallow. You put food in your mouth and close your lips to keep it in. The tongue moves the food around in the mouth. Saliva moistens the food and your teeth break it down until it forms a soft, moist ball. This is called a bolus and is ready to swallow.

Swallowing happens in three stages. These are shown in the diagrams below. We have used numbers to show what happens at each stage. The food bolus is shown as green in the diagrams. Eating difficulties can be caused by problems at one or more of these stages.

Mouth stage of swallowing

  1. When the food bolus (shown in green in the diagram) is ready to be swallowed, the tip of the tongue squeezes against the roof of the mouth. This moves the food to the back of the throat (pharynx).
  2. The soft palate moves up, closing the gap between the nose and mouth. This stops food from moving into the nose.
Mouth stage of swallowing
Mouth stage of swallowing

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Throat (pharyngeal) stage of swallowing

  1. As food moves into the throat, the muscles in the base of the tongue and throat (pharynx) squeeze together. This moves the bolus of food down.
  2. Your voice box (the larynx) lifts in your throat and a flap of tissue called the epiglottis moves to close the airway and stop food going into the airways and lungs. The vocal cords close and the voice box moves upwards to further protect the airway. The gullet (oesophagus) opens.
Throat stage of swallowing
Throat stage of swallowing

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Gullet (oesophageal) stage of swallowing

  1. Muscles in the gullet squeeze and relax, pushing food down towards the stomach.
Gullet stage of swallowing
Gullet stage of swallowing

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How treatments can affect chewing and swallowing

Surgery for mouth cancer can affect chewing and the mouth stage of swallowing. If only a small amount of tissue is removed, the change may be small and 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 as part of your treatment, or you have dentures that no longer fit, your ability to grind food during chewing may change.

Muscles and nerves that control the lips, tongue or other parts of your mouth can be affected by surgery or radiotherapy. This can make it difficult to control food and fluid in your mouth. It may also affect your ability to sense where food is in your mouth.

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

Surgery to the 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 tissues in the throat and gullet weaker and less stretchy. This can make it harder to swallow some types of food or cause some foods to stick in the throat. If nerves that control the muscles in the gullet are affected, this can also weaken the muscles so they are less able to move food downwards.

The upper part of the gullet may be narrower after radiotherapy. It may also be 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, which is called fibrosis. Tell your SLT, specialist nurse or doctor if you have difficulty swallowing or if you are experiencing any of the following things:

  • a deterioration in your ability to swallow
  • drooling or dribbling when eating
  • food coming down your nose
  • food getting trapped in one side of your mouth
  • biting your tongue or the inside of your cheeks
  • feeling that you have too much saliva
  • food sticking in your throat
  • choking or coughing when eating or drinking
  • a wet- or gurgly-sounding voice
  • repeated chest infections
  • weight loss.

There are many things that can help with changes to chewing and swallowing. See our information on managing problems with eating and drinking after treatment.