The incidence of trismus in patients with H&N cancer is non-negligible. Trismus severely impairs HRQL and negatively affects daily life activities in patients with H&N cancer. Further studies regarding symptomatic treatment of patients with trismus are highly warranted. The symptom-specific questionnaire GTQ is useful to identify the problems in this group of patients given it is responsive to showing change over time.

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Objective To develop and validate a comprehensive, self-administered questionnaire for patients with limited ability to open the mouth, trismus. Materials and methods We derived the Gothenburg Trismus Questionnaire (GTQ) from empirical evidence in the medical literature and interviews with medical experts as well as patients. The draft version was tested in a pilot study (n=18). Patients with a maximal incisal opening (MIO) of ≤ 35 mm were included. The study comprised patients with benign jaw-related conditions (n=51), patients treated for head and neck (H&N) cancer (n=78) and an age- and gender-matched control group without trismus (n=129). Results The GTQ instrument was well accepted by the patients, with satisfactory compliance and low rates of missing items. After item reduction, due to items not being conceptually relevant and/or low factor loadings, the GTQ demonstrated high internal consistency (Cronbach’s alpha 0.72–0.90), good construct validity and known-group validity. Conclusion We developed a trismus-specific self-administered questionnaire, the GTQ, that showed good psychometric properties. We suggest this questionnaire, that has clear clinical relevance, to be adopted and used in clinical practice and in research, acting as a screening tool as well as an endpoint in intervention and jaw physiotherapy/rehabilitation studies.

Jaw exercise therapy effectively improved mouth opening capacity and led to less trismus-related symptoms. Both jaw devices were proved efficient and compliance to exercise was comparable.

Background This study aims to investigate the long-term effects of structured trismus intervention in patients with head and neck cancer (HNC) and trismus in terms of mouth opening, trismus-related symptoms and health-related quality of life (HRQL). Material and methods Fifty patients with HNC to receive radiotherapy ± chemotherapy were included in this prospective study along with a matched control group. The intervention group received a 10-week structured exercise with a jaw mobilizing device (TheraBite® jaw device or Engström device). Patients were assessed before and after trismus exercise intervention and at a two-year follow-up. Primary endpoint was maximum interincisal opening (MIO) and secondary endpoints included trismus-related symptoms and HRQL assessed with patient-reported outcome (PRO)-instruments [Gothenburg Trismus Questionnaire (GTQ), European Organization for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) and the related HNC-specific module the EORTC Head & Neck Questionnaire (EORTC QLQ-H&N35)]. Results The intervention group had a higher MIO at the two-year follow-up compared to the control group (40.5 mm and 34.3 mm, respectively), which was statistically significant. The intervention group also reported less jaw-related problems according to the GTQ and higher functioning as measured by EORTC QLQ-C30 and QLQ-H&N35 compared to the control group. Conclusion A positive persistent effect of exercise intervention for trismus in HNC patients was found with regard to MIO, trismus-related symptoms and HRQL. Exercise intervention is important in long-term treatment of radiation-induced trismus in HNC patients. The trismus-specific questionnaire, GTQ, is a valuable tool for observing and evaluating trismus over time.

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Purpose This study aims to examine effects of jaw exercise on trismus 3 years following completion of a post-radiotherapy jaw exercise intervention. Methods Prospective study including 50 patients with head-and-neck cancer receiving radiotherapy and/or chemotherapy, plus a matched control group. The intervention group underwent 10 weeks of jaw exercise training. Patients were followed pre-and postintervention and 3 years postintervention completion. Outcome measures were maximal interincisal opening (MIO), trismus-related symptoms, and health-related quality-of-life as measured by Gothenburg Trismus Questionnaire, EORTC QLQ-C30, and EORTC QLQ-H&N35. Results The intervention group had a statistically significantly higher mean MIO compared with the control group (40.1 mm and 33.9 mm, respectively, p < 0.001), reported less trismus-related problems and had an improved health-related quality-of-life when compared with the control group at the 3-year follow-up. These differences were all statistically significant. Conclusion Jaw exercise therapy resulted in increased MIO, less trismus-related symptoms, and improved health-related quality-of-life. Jaw exercise therapy should be initiated early, in a structured manner and continued long-term.

Mouth-opening distances in patients with HNC post-RT can be understood in terms of associated patient-reported outcomes on trismus-related difficulties. Our data suggest that a reduction in MIO can be expected as patients communicate their mouth-opening status to interfere with private/social life, a clinical warning signal for emerging or worsening trismus as patients are being followed after RT.