[Prehabilitation training program for patients with head and neck tumors-pathophysiology, target structures, and...

Oropharyngeal dysphagia secondary to head and neck cancer is common and significantly impacts quality of life, morbidity, mortality, and 5‑year survival rates. Functional impairments can result from tumor mass, location, surgical interventions, and (adjuvant) radio- or chemotherapy. Early identification of deficits and assessment of individual patient resources by a multidisciplinary team enable the development of tailored, targeted prehabilitative exercise programs aimed at preventing functional decline and fostering compensatory mechanisms. Central pathophysiological factors of dysphagia include reduced tongue base retraction, laryngeal elevation, and pharyngeal constriction. Other factors include epiglottis retroflexion and radiation therapy-induced mucositis or postoperative scarring and fibrosis. The speech therapy exercises most frequently reported in studies include the Masako, Shaker, and Mendelsohn maneuvers; chin tuck against resistance (CTAR); and expiratory muscle strength training (EMST). Studies suggest a reduction in muscle atrophy and functional limitations through early initiation of swallowing exercises, but the evidence is limited due to small heterogeneous study populations and inconsistent designs. Further prospective studies are needed to systematically evaluate the timing, intensity, and lasting impact of prehabilitative measures in the context of new therapeutic approaches.