Dynasplint for the Management of Trismus after Treatment of Upper Aerodigestive Tract Cancer: A Retrospective Study

Abstract

In order to evaluate the Dynasplint Trismus System (DTS) for the relief of trismus secondary to the treatment of head and neck cancer, we conducted a retrospective chart review of patients who had undergone DTS therapy during a 1-year period. Our inclusion criteria were cancer of the upper aerodigestive tract; treatment with radiation, chemotherapy, and/or surgery; and a maximal incisal opening (MIO) of less than 30 mm. MIO and the rate of improvement of trismus ("gain") were measured at selected intervals. Twenty-six patients met our study criteria; their pretherapy mean MIO was 19.3 mm. At the time of their most recent measurement, the mean MIO had increased to 25.5 mm-a measured gain of 32%. Although the initial rate of gain was 0.36 mm/day during the fi rst 6 weeks, improvement leveled off over time, and the overall rate of gain was 0.16 mm/day. We conclude that the DTS is eff ective in increasing the mandibular range of motion at a rate of change that is maximized during initial treatment.

Radiation-induced fibrosis: mechanisms and implications for therapy

“…For example, physiotherapy has been shown to be effective in reducing lymphedema and preserving shoulder motion post-radiation in patients with breast cancer, and the LPG Systems mechanical massage technique has been shown to reduce RIF in breast cutaneous tissue (Bourgeois et al 2008; Box et al 2002). For patients with head and neck cancer that have trismus post-radiation, progressive increases in mouth opening using tongue blades, the Dynasplint Trismus System, or the TheraBite Jaw Motion Rehabilitation System have been recommended (Baranano et al 2011; Grandi et al 2007; Kamstra et al 2013; Melchers et al 2009; Sciubba and Goldenberg 2006; Shulman et al 2008; Stubblefield et al 2010). Coronoidectomy has been shown to be efficacious in refractory cases (Bhrany et al 2007), although careful thought and consideration must be given to this intervention as surgery may lead to even greater fibrosis.…”

TheraBite exercises to treat trismus secondary to head and neck cancer

“…In that study, the interval between oncological treatment and initiation of exercise therapy was approximately 4 years [23]. In a preliminary report and in a case series, mouth opening increased on average with 11.0 and 13.6 mm, respectively, after exercises with the DTS [18, 22].…”

“…Jaw-stretching devices demonstrated efficacy in improving trismus of head and neck cancer patients in several studies with different designs [18, 20–23]. …”

“…Exercises with the Dynasplint® Trismus System (DTS) increased mouth opening between the 6.2 and 13.6 mm, as described in a case series, a preliminary report, and in a retrospective study [18, 22, 23]. Exercises with the TheraBite® Jaw Motion Rehabilitation System™ (TheraBite) increased mouth opening with 13.6 and 10 mm, as described in a randomized controlled trial with short follow-up ( n  = 21 with 10 weeks follow-up) and in a pilot study with small sample size ( n  = 7 with 12–48 weeks follow-up), respectively [20, 21].…”

The effect of exercise therapy in head and neck cancer patients in the treatment of radiotherapy-induced trismus: A systematic review

“…A systematic literature search in four electronic bibliographic databases was conducted in July 2014. Although some of these treatments are effective in trismus in general [11][12][13][14][15], their value for the treatment of radiotherapy-induced trismus is largely unknown. Best available evidence was analyzed and compared.…”