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This cross-sectional study characterizes mastication problems using clinical and instrumental assessments in patients with spinal muscular atrophy (SMA) types 2 and 3 with self-reported bulbar problems. We included 27 patients (aged 13\u201367\u00a0years), 18 with SMA type 2 and 9 patients with SMA type 3 (of whom three were still ambulant) and applied a questionnaire, clinical mastication tests (TOMASS and 6-min mastication test), and muscle ultrasound of the mastication muscles. Non-ambulant patients demonstrated inefficient mastication as reflected by median <jats:italic>z<\/jats:italic> scores for masticatory cycles (<jats:italic>z<\/jats:italic>\u2009=\u20091.8), number of swallows (<jats:italic>z<\/jats:italic>\u2009=\u20094.3) and time needed to finish the cracker (<jats:italic>z<\/jats:italic>\u2009=\u20093.4), and limited endurance of continuous mastication as demonstrated by the median <jats:italic>z<\/jats:italic> scores of the 6-min mastication test (<jats:italic>z<\/jats:italic>\u2009=\u2009\u2212\u00a01.5). Patients reported increased fatigue directly after the 6-min mastication test as well as 5\u00a0min after completing the test (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; <jats:italic>p<\/jats:italic>\u2009=\u20090.003). Reduced maximal mouth opening was associated with mastication problems (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Muscle ultrasound of the mastication muscles showed an abnormal muscle structure in 90% of both ambulant and non-ambulant patients. This study aims to understand the nature and underlying mechanisms of mastication problems in patients with SMA types 2 and 3 with reported bulbar problems.<\/jats:p>","DOI":"10.1007\/s00455-021-10351-y","type":"journal-article","created":{"date-parts":[[2021,8,15]],"date-time":"2021-08-15T14:02:35Z","timestamp":1629036155000},"page":"715-723","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Mastication in Patients with Spinal Muscular Atrophy Types 2 and 3 is Characterized by Abnormal Efficiency, Reduced Endurance, and Fatigue"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1231-7035","authenticated-orcid":false,"given":"A. M. 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WLP receives research support from the Prinses Beatrix Spierfonds, Stichting Spieren voor Spieren and Vriendenloterij. His employer receives fees for ad hoc consultancy services to Biogen, Avexis (member scientific advisory board), and Novartis (member data-monitoring committee).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}