Jaw and Facial Muscle Exercises for Dysphagia in HK

Oral motor control is the foundation of safe eating. The jaw, lips and facial muscles work together to ensure food is adequately chewed, formed into a bolus and contained within the oral cavity before swallowing. When any of these structures weakens — due to stroke, neurological disease, head and neck cancer treatment or simple disuse — swallowing safety is compromised from the very first stage. This guide outlines the jaw and facial muscle exercises recommended by Hong Kong SLTs for home practice.

How Jaw and Facial Muscles Contribute to Swallowing

Jaw function

• Chewing: breaks down solid food textures into manageable bolus sizes
• Mouth opening: affects how efficiently food can be placed and positioned

Lip function

• Lip seal: prevents food and liquid leaking from the corners of the mouth during eating and drinking
• Lip compression: generates the negative pressure needed for straw drinking

Cheek (buccinator) function

• Keeps food on the chewing surfaces during mastication
• Prevents food pocketing in the lateral sulci (side cheek pouches)

Important: SLT Supervision Required

All exercises must be prescribed by a registered SLT. Patients with a history of head and neck surgery or radiotherapy should obtain medical clearance before beginning jaw mobility exercises, as forceful jaw movement can affect healing tissue.

Jaw Exercises

1. Jaw Range of Motion (ROM) Exercises

Target: Improves jaw opening, lateral and protrusive range — particularly relevant for post-radiotherapy trismus

Vertical opening

1. Open the mouth slowly to its maximum comfortable range
2. Hold for 5 seconds; close slowly
3. Repeat 10 times

Lateral movement

1. Move the jaw to the left; hold 3 seconds
2. Return to neutral; move right; hold 3 seconds
3. 10 repetitions per side

Protrusive movement

1. Slide the jaw forward until the lower teeth are in front of the upper teeth; hold 3 seconds
2. Return to neutral; repeat 10 times

2. Jaw Resistance Training

Target: Strengthens the masseter and temporalis muscles used in chewing

Equipment: Tongue depressor or a purpose-made jaw training device (provided by SLT)

Bite resistance

1. Place the tongue depressor between the back teeth (approximately 3 cm in)
2. Bite down firmly on the depressor and gradually increase force
3. Hold 5 seconds; release; repeat 10 times

Caution: Patients with temporomandibular joint (TMJ) dysfunction must obtain medical clearance before any jaw resistance training.

Lip Exercises

3. Lip Closure and Strength Training

Target: Improves lip seal to reduce food and liquid leakage during meals

Movement A — Sustained lip closure

1. Press the lips firmly together as if saying “mmm” with effort
2. Hold 5–10 seconds; relax
3. Repeat 10–15 times

Movement B — Tongue depressor lip resistance

1. Place a tongue depressor (or clean chopstick end) horizontally between the lips
2. Hold it in place using lip strength alone — resist if someone attempts to pull it out
3. Hold 10 seconds; repeat 10 times

Movement C — Lip mobility

1. Alternate between an exaggerated “ee” (lips spread wide) and “oo” (lips rounded) shape
2. Hold each position 2 seconds; repeat 15–20 times

Cheek Exercises

4. Cheek (Buccinator) Strengthening

Target: Reduces food pocketing in the lateral cheek pouches and maintains food on the chewing surfaces

Movement A — Cheek puffing and transfer

1. Seal the lips and inflate the cheeks with air
2. Transfer the air from the left cheek to the right, then back; repeat 10 times
3. Finish by sucking the cheeks inward and blowing the air out forcefully

Movement B — Cheek retraction

1. With lips closed, suck the cheeks inward strongly to create a “fish face”
2. Hold 5 seconds; relax
3. Repeat 10–15 times

Special Considerations: Trismus After Head and Neck Cancer Treatment

Trismus — restricted jaw opening — is a common complication of radiotherapy to the head and neck region in Hong Kong patients treated for nasopharyngeal carcinoma (NPC) or other head and neck cancers. NPC is significantly more prevalent in the Cantonese-speaking population than in Western countries, making trismus management particularly relevant in Hong Kong.

HA head and neck cancer multidisciplinary teams (MDTs) typically include SLT referral during or after treatment. Specialist jaw mobilisation devices such as TheraBite or Dynasplint may be prescribed for patients with significant restriction. Do not attempt forceful jaw stretching without a device specifically designed for this purpose and without SLT or physiotherapy supervision.

Training Frequency Guide

When to Contact Your SLT

• Jaw or facial pain during or after exercise
• Worsening facial asymmetry (may indicate a neurological change)
• No improvement after two weeks of consistent training
• Persistent food pocketing requiring manual finger sweeping after every meal

Jaw and facial muscle training complements the broader dysphagia rehabilitation programme. Working closely with an HA or private SLT to develop a personalised exercise plan is the most effective path to improving oral motor function and eating safety in Hong Kong.