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result of necessary surgical treatment of parotid or skull base tumours. Despite the fact that cancer patients have not been studied separately, it can be concluded that mime therapy is meaningful for patients with facial paresis, regardless of its cause. It should however be noted that an active stance on the patient\u2019s side is essential (active home practice is required).\u000D5.4 Dietician\u000D5.4.1 Hydration and nutritional problems in head and neck cancer patients\u000D5.4.1.1 Definition and prevalence of malnutrition\u000DHead and neck cancer patients have an increased risk of malnutrition before, during and after cancer treatment (Chasen and Bhargava 2009, IKNL-a 2012, Vogel, Beijer et al. 2012, Langius, Zandbergen et al. 2013, Van den Berg 2014). Malnutrition may be caused by the location of the tumour, metabolic effects of the tumour, alcohol abuse and toxicities of the (multimodal) cancer treatment (Chasen and Bhargava 2009, IKNL-a 2012, Vogel, Beijer et al. 2012, Langius, Zandbergen et al. 2013, Van den Berg 2014). The patient\u2019s medical history, presence of the tumour in the head and neck area and treatment of the tumour may lead to symptoms such as chewing and swallowing problems, mucositis, nausea, changes in taste and smell, xerostomia and trismus (Van den Berg 2014). These symptoms are characteristic of the head and neck cancer patient population, and they increase the risk of malnutrition.\u000DMalnutrition is defined as; \u2018Nutritional status where there is a deficiency or imbalance of energy, protein and/or other nutrients, leading to measurable adverse effects on body size and body composition, functioning and clinical results\u2019 (Vogel, Beijer et al. 2012). In the Netherlands the criteria for malnutrition are unintended weight loss \u2265 10% within six months, or \u2265 5% within one month in combination with a Body Mass Index (BMI) of \u2264 18.5. For patients of \u2265 65 years a BMI is maintained of \u2264 20 (Vogel, Beijer et al. 2012). Before the treatment of head and neck tumours 3-57% of patients are malnourished (Chasen and Bhargava 2009, Langius, Zandbergen et al. 2013, Van den Berg 2014). The highest incidence of malnutrition is found in the group of pharyngeal and oral cavity tumours (Jager- Wittenaar, Dijkstra et al. 2007, Van den Berg 2014). There is some indication that malnutrition is more prevalent in patients with advanced cancer than in patients with early-stage cancer (Jager-Wittenaar, Dijkstra et al. 2007, IKNL-b 2012). During treatment involving radiotherapy alone (RT) or combined radiotherapy and chemotherapy (CRT) the percentage of malnourished patients rises to 44-88% (Langius, Zandbergen et al. 2013). The guideline \u2018General Nutrition and Dietary treatment\u2019 emphasises the importance of an active perioperative dietary protocol (IKNL-a 2012). Malnutrition is seen as an independent risk factor for developing postoperative complications (IKNL-b 2012).\u000DIn the case of cancer-related malnutrition, it is important to distinguish between two underlying mechanisms (IKNL-a 2012, IKNL-b 2012, Vogel, Beijer et al. 2012, Beelen, Van Dooren et al. 2013).\u000D1.\u000D2.\u000DInsufficient intake of nutrition\u000DThe malnutrition is caused by insufficient intake of nutrition due to loss of appetite, obstruction, function loss (such as reduced chewing or swallowing function), pain, fatigue, problems of the gastrointestinal tract or increased nutritional requirements (such as during wound healing, vomiting, diarrhoea). Factors such as psychosocial stress or infirmity, too, may lead to insufficient intake of nutrition.\u000DInflammation and metabolic deregulation\u000D118\u000D