Cancer of the face, mouth, head and neck

The first symptoms can be hoarseness, lumps, warts or ulcers in the mouth which will not heal. Alternatively it can be a constant ’lump in the throat’ feeling, difficulties in eating and swallowing that may be more or less pronounced. General advice from the cancer charities is to seek medical advice if the symptoms are still present after 3 weeks. ^[1]

If you always experience a blockage when trying to swallow food morsels above a certain size, this can indicate some form of narrowing of the esophagus, for example because of a build-up of scar tissue, or pockets forming in the side of the esophagus, or a tumour – so-called constant dysphagia. If this is suspected you should immediately asked to be referred to a specialist doctor, surgeon or gastroenterologist. ^[2]

After an operation where, for example, a part of the tongue, jaw or face has been removed along with a cancer tumour, and radiation or cytostatic treatment has been used, it is usual that swallowing and speech difficulties occur in some form. Also, with skin cancer in the face or tumour in the brain, complications during or after the treatments can give rise to speech- or swallowing difficulties or a facial dysfunction – paralysis.

Functionality of the face, mouth, pharynx and neck can be reduced by side effects of the cancer treatment: such as nerve and tissue injuries or bleeding. The functions in the face, mouth, neck and pharynx can be affected, and this will cause problems with swallowing and speech difficulties. With these types of injuries it is mostly that the muscle strength and the coordination between various muscle groups are affected or reduced.

These are the muscles used for speech and the successive swallowing phases in the swallowing process. The entire swallowing process from the lips to stomach is complicated; involving 148 muscles, several salivary glands and five brain nerves: CN, (cranial nerve) Trigeminus, Facialis, Glossopharyngeus, Vagus and Hypoglossus. This complex system is sensitive to even small injuries, and these can limit quality of life as we shall see.

Different degrees of swallowing difficulty

Difficulties can vary from problems in closing the mouth or an unreliable swallowing reflex, to a problem that sits much deeper in the pharynx or esophagus.

It’s also common that saliva production can be affected negatively and lead to dryness in the mouth, which makes it more difficult to process and break down food in the mouth, and to swallow it. Food regularly becomes stuck in the throat with the risk that it enters the air pathways – causing coughing fits as a result. Such a misdirected swallow can also occur without a subsequent coughing bout – a so-called ’silent aspiration’ – which is more serious since the coughing helps to clear the misdirected food.

To minimize the risk of pneumonia it is very important to maintain good oral hygiene, that you brush your teeth with a soft toothbrush and clean between your teeth with dental floss or a toothpick. It is in fact not the misdirected swallowing itself that causes pneumonia, but the bacteria caused by poor oral hygiene which are drawn down into the lungs.

Tips for safer swallowing after cancer treatment

To make swallowing easier, and minimise the risk of swallowing incorrectly after cancer treatment to the face, mouth, head or neck, read the following tips.

1. Liquids should be mixed with a thickening agent or gelatine product to produce a more viscous consistency. It is also important not to mix food with different consistencies in the same bite. For example, if you eat a bowl of chopped fruit in its syrup or juice, you should eat the fruit chunks and drink the juice separately.
2. Adjust your sitting position. Sit upright, look straight forward and hold your head slightly inclined downwards.
3. Before swallowing, breathe in and hold your breath tightly; this closes the vocal cords.
4. After swallowing, make a short cough to clear your throat and to force out any food remains that have lodged above the vocal cords.

Most people with cancer receive radiation treatment before or after the operation, which can disable the salivary glands and cause dry, irritated or even wounded mouth membranes. Eating is painful, and you may have to anaesthetise the mouth with, for example, Xylocain gel. You may also have to drink a great deal of water to help wash down your food.

Counteracting dryness of the mouth

To counter dryness of the mouth you can salve your lips with beeswax and moisten your mouth with different types of gels or saliva substitute preparations, preferably with oily ingredients like sunflower oil. Choose a preparation without fluorine in order to be able to use it as often as you need. The production of saliva is also important for your teeth – so maintain good oral hygiene and drink water regularly.

If a part of your tongue has been removed

The tongue is important both for speech and the swallowing function. Even if nearly half of the tongue has been excised a great deal of its function can be retained. However, if the majority of the rear of the tongue has been removed in an operation, severe swallowing difficulties will arise. Liquids can run into the pharynx in an uncontrolled manner, and into the air pathways causing coughing.

Damage to the front palate by radiation or surgical operation

The swallowing reflex is initiated when the food has passed the front palate – anterior palatal arch. If this is injured during an operation or subjected to radiation damage it is difficult to trigger the swallow reflex.

It may help to lie down with a pillow under the crown of your head, preferably with your chin tucked down to your chest when you swallow. You should be in calm surroundings, and absolutely not talk whilst you’re eating. It can also be an advantage if you breathe in and hold your breath before you swallow.

It is also important to not mix food with different consistencies in the same bite. For example, if you eat a bowl of chopped fruit in its syrup or juice, you should eat the fruit chunks and drink the juice, separately.

Du bör ha det lugnt omkring dig och du bör absolut inte tala med någon när du äter. Det kan också vara en fördel om du andas in och håller andan hårt innan du sväljer. Det är även viktigt att inte blanda mat med olika konsistens i samma tugga t.ex. om du äter gröt med mjölk, bör mjölken tas för sig. 

If you have been struck by cancer in the lymph glands, for example a secondary tumour in the neck, you would usually have powerful radiation treatment in the neck region.

Radiation therapy can thought of as like a burn injury in the tissue which causes scar tissue to build in the lower layers of the skin and its underlying tissue. This can cause, as well as nerve damage, locking in the pharynx musculature which makes swallowing more difficult and can allow misdirected swallowing.

IQoro is a unique neuromuscular treatment method that requires just 30 seconds’ exercise, three times per day. Training with IQoro after a cancer treatment can improve muscle strength and coordination, for a safer and more effective swallowing function.

Exercising with IQoro, a natural neuromuscular treatment, reaches the muscles in the face, oral cavity, pharynx, esophagus, and down to the diaphragm, and in this way can improve a range of various functions: even for those that have been treated for cancer of the face, mouth, head and neck. This can include a better ability to be able to use the face’s expressive musculature, and to speak, eat and swallow more easily.

Get started with your IQoro

Get started with your new daily routine. Instruction manual and free support are included.

Neuromuscular training with IQoro takes only 90 seconds a day and strengthens 148 muscles from your mouth to your stomach.

Treatment with IQoro has proven efficacy in internationally published scientific studies.

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IQoro counters dryness in the mouth

Training with IQoro also contributes by stimulating the glands in the lower lip and palate roof which produce the lubricating saliva, as well as the salivary glands in the cheeks and under the tongue which produce the thin, fluid saliva. This helps to counter dryness in the mouth, and is explained as follows:

Training with IQoro reaches the brain’s control system for the swallowing process, in which signals are sent via various fibres, so-called motorneurons, to the brain stem, and down to the muscles and glands which are to be activated.

There are three different types of fibre, of which the third, the General Visceral Efferent (GVE) nerve is included in the brain nerves CN Facialis and Glossopharyngeus and sends signals to the tear glands and the saliva glands, amongst others. This explains why treatment with IQoro can have a positive effect on dryness in the mouth.

Scientific research

It is not yet scientifically proven that training with IQoro has an effect on the possible complications of treatment of cancer of the face, mouth, head and neck. But it is credible from earlier clinical experience and over 20 years’ research, that IQoro can function effectively as an alternative treatment, or as a complement to other treatments.

This research shows, amongst other things, that the musculature in the face, oral cavity, pharynx and the esophagus, and down to the diaphragm achieve an improved function through training with IQoro. 

Research ^[5] shows that IQoro acts on, and regenerates, the entire swallowing process. It stimulates the sensory nerves in the mouth, and by doing this reaches the brain’s control system for the swallowing process, which is closely linked to the control systems for other bodily functions ^[6], including breathing, the ability to form sounds (speech), facial expression, postural control ^[4], stomach and intestine functions, and more. This explains why exercising with IQoro can have a positive effect on so many different bodily functions.

Read more about the research.

1. Cancerfonden, (2015), munhåle-svalg-strupcancer: https://www.cancerfonden.se/om-cancer/cancersjukdomar/huvud-hals-cancer
   (English translation, ”Cancer of the oral cavity, pharynx and throat”).
    
2. Tibbling Grahn L., Med dr., professor emerita, (2004), Svenska dysfagiförbundet – Cancer och dysfagi, pdf.(English translation, ”The Swedish dysphagia association – Cancer and dysphagia”).
    
3. Cancerfonden.se (2014), Matstrupscancer, text granskad, Jesper Lagergren Professor, Karolinska universitetssjukhuset, https://www.cancerfonden.se/om-cancer/cancersjukdomar/matstrupscancer
   (English translation, ”Cancer of the esophagus”).
    
4. Hägg M., Tibbling L. Effect of IQoro® training on impaired postural control and oropharyngeal motor function in patients with dysphagia after stroke. Acta Otolaryngol 2016; 136 (7):742-748. DOI:10.3109/00016489.2016.1145797 https://www.tandfonline.com/doi/full/10.3109/00016489.2016.1145797
5. Forskning bakom IQoro® – se separat artikellista, klicka här.(English translation, ”The research behind IQoro^® – see separate list of articles”).
    
6. Ekberg O, (2011), Röntgendiagnostiska avdelningen, Universitetssjukhuset MAS, Malmö, Normal sväljning inklusive anatomi och fysiologi, (pdf). Hämtad 2015-12-05,http://media1.dysfagi.se/2011/06/svaljningssvarigheter.pdf
   (English translation:” Normal swallowing including anatomy and physiology”).