In a maxillofacial context, the majority of cases of dysphagia are managed by non-surgical means, including restorative dentistry, speech & language therapy, physiotherapy, mental health support and occupational therapy – many approaches with a major component of self-help. Speech and language therapy plays a major role in the compensatory approach to dysphagia management, by assessment and monitoring, and by swallowing rehabilitation and training. This includes a number of swallowing manoeuvres that, combined with suitable food textures, can help enable safe swallowing and oral food intake, often despite significant impairments. Speech and language therapists typically are also a good source of practical information and pragmatic ways to work around difficulties. Adaptions may include individually optimised food textures and temperatures, special cutlery, and many other useful tips & tricks, alongside developing new habits such as not talking while eating.

Surgical and non-surgical interventions

Below we give an overview of some surgical and non-surgical interventions addressing dysphagia in a maxillofacial surgery context. Some of these interventions aim to address specific symptoms of chronic dysphagia (for example, nasal regurgitation or aspiration), others aim to support non-surgical dysphagia management. Many relevant interventions are described in other sections of the website.

The role of surgical interventions in the management of dysphagia in progressive neuromuscular conditions is not well defined and is controversial. Medications used in the management of some neuromuscular degenerative conditions, such as Parkinson’s disease or myasthenia gravis (autoimmune condition leading to muscle weakness) can also mitigate related dysphagia problems, at least temporarily. Otherwise, medications play only a minor role in the management of dysphagia.

Figure 1: Resected left & right submandibular glands and ducts.

A slightly less radical and temporary option to manage sialorrhea can be injection of botulinum alpha toxin into the submandibular glands. This is an option if reduction of ‘resting’ salivary flow (mostly from the submandibular glands) is sufficient to reduce drooling to a manageable level.