10 thus preventing aspiration of foreign materials into the trachea before or during swallowing.16 Since there is a brief pause in breathing when swallowing food, food should be chewed well and mixed with saliva to minimize swallowing time and the associated brief cessation of breathing.17 This pause in breathing is caused by the inhibition of respiration in neural control centers in the brainstem, and not simply due to closure of the upper airway.16 The esophageal phase consists of a peristaltic wave of muscle contraction, which propagates to the stomach. Head and neck cancer Head and neck cancer (HNC) is the seventh most common cancer worldwide, and develops in the mucosal surfaces of the upper aero digestive tract.18 HNC can be divided into different sub sites: the oral cavity (including the lips, tongue, floor of the mouth, hard palate, and gum), the pharynx (including the oropharynx, hypopharynx and nasopharynx), the larynx (supraglottic, glottic, and subglottic regions), the nasal cavity and paranasal sinuses, and the salivary glands. Risk factors for developing HNC are alcohol and tobacco (ab)use, or viral infections such as the human papilloma virus (HPV).18 Curative treatment options for HNC include surgery, radiotherapy (RT), chemoradiotherapy (CRT), or a combination of these treatment modalities. The type of treatment depends on the tumor site, tumor stage and patient characteristics. Early-stage cancers are usually treated with either surgery or RT, while locally advanced cancers are treated with surgery followed by adjuvant radiation or chemoradiotherapy.19 In addition, oral cavity tumors are most often treated with surgery, while oropharynx and larynx tumors are primarily treated with RT. Surgery The main goal of surgery is complete tumor resection while maximizing post-operative function. This is often difficult to achieve, and depends on several variables such as tumor size and location, neck involvement, type of surgical reconstruction and dental status of the patient.3 Surgery may require wide resections of one or multiple sub sites, including tongue, floor of mouth, or lower gingiva.20 It may be combined with reconstruction of the tumor site by a tissue transfer and/or neck dissection. A laryngectomy, in which the total larynx is removed, may be needed for advanced stage IV tumors. Radiotherapy RT uses ionizing radiation that damages and/or destroys all cells receiving a radiation dose, including normal tissue cells surrounding the tumor. By increasing the dose, the probability to destroy malignant cells increases as well. However, in order to spare healthy tissue, the dose to these fields has to be limited. It is therefore important to create a balance in which
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