Exercises to do after Oral Surgery to improve your Swallowing and Speech
By Carol Glaister
How we swallow
To understand the impact of your treatment, it is useful to see how we swallow. First, we take the food or drink into our mouths; our jaw widens, opens and then closes, and then our lips close to stop the food or drink from falling out.
Our tongue moves in a figure of eight fashion to push food between our upper and lower jaw and our teeth to break it up and mix it with saliva, which is produced by salivary glands. When we are ready to swallow, the tongue brings the food back into the middle of the tongue before moving backwards, taking the food with it. Several things then happen in quick succession: the soft palate (end of the roof of the mouth) moves back and upwards and the back of the throat moves forwards slightly to meet it causing it to seal off the nose and stopping food or drink from coming down the nose. The larynx (voice-box) rises upwards, the epiglottis (flap of muscle and tissue at the base of the tongue) moves downwards, closing the airway, stopping food or drink from going into the lungs. As the larynx rises, the top of the oesophagus (food-pipe) opens to receive the food and this travels down into the stomach to be digested.
How swallowing is after surgery:
It is difficult to predict exactly how your swallow will be after surgery as it will depend on several factors, some of which are:
• How much tissue or muscle that has had to be removed to take away the cancer,
• what nerves or muscles are working after the surgery,
• the size and shape of the flap of skin and muscle that has been put into your mouth to fill the gap,
• which part of the mouth has had surgery,
• whether you have had previous surgery or illnesses affecting your ability to swallow,
• whether any salivary glands have had to be removed thus making your mouth drier,
• whether you have teeth or dentures,
• how your mouth heals, e.g. the amount of pain or swelling there is,
• and how tired you are feeling.
Speech and Language Therapy Exercises
Your Speech and Language Therapist will go over this sheet with you and tick the exercises that are the best for you to do. It is best to do these little (no more than 10 minutes) and often (up to ten times a day), before you try to eat or drink anything.
• Gaining greater tongue control .
Take a Polo and thread some cotton through the hole. Put it in your mouth and practise moving it around your mouth with your tongue, let it fall towards your cheek and try to move your tongue to bring it back into the middle of your mouth. If you find it difficult, slightly pull the thread to help your tongue.
• Improving tongue movement
Move your tongue from side to side, cup your chin in your hands to stop your jaw from moving. Now push your tongue against your cheek on one side and hold it there for 5 seconds, now try it on the other side.
• Working on tongue precision
Try saying the following words as clearly and slowly as you can: caterpillar, hospital, particular, blue, practical, special, spring, splade, trouble, trigger, crisp, crunch, slip.
• Increasing forward and backward tongue control
Stretch your tongue gently, sticking it out as far as you can and then bring it back as far as you can (think of the sound ‘k’ as you move your tongue back).
• Gaining greater lip control
Practise holding your lips as closely together as possibly. Now blow up your cheeks, with your lips still tightly closed and try to stop any air from coming out, now release.
• Improving lip movement
Purse your lips forward, as if you are about to whistle (or say ‘oo’) and then stretch them, as if you are grinning widely.
• Gaining greater jaw movement
Open your mouth as wide as you can without making it hurt, hold it open for five seconds, then move your jaw to one side, hold it open and then move it to the other side and hold it open, both for five seconds each.
• Improving jaw movement
Practise chewing with nothing in your mouth, chew slowly and exaggeratedly. Take a piece of red liquorice and hold it forward with only a small amount in your mouth and practise chewing against it. Do not try to eat it (unless you have been advised it is safe for you to do so).