Longitudinal evaluation of restricted mouth opening (trismus) in patients following primary surgery for oral and oropharyngeal squamous cell carcinoma

Scott, B.; D'Souza, Jacob; Perinparajah, N.; Lowe, Derek; Rogers, Simon N.

doi:10.1016/j.bjoms.2010.02.008

Cited by 68 publications

(106 citation statements)

References 17 publications

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“…Longitudinal course of mouth opening following surgery and/or RT (with or without chemotherapy) and risk factors for decrease in mouth opening have been described in 4 prospective studies [17,19,23,24]. In one study, a rapid decrease of mouth opening between 1 and 9 months was found and a slower rate of decrease after 1 year in 17 patients treated for nasopharyngeal cancer following RT.…”

Section: Other Studiesmentioning

confidence: 94%

“…The longitudinal course of mouth opening up to 1 year following surgery and/or RT (with or without chemotherapy) has been described in 4 prospective studies with 17 to 143 patients. The main limitations of these studies were the small sample sizes, limited primary tumor sites, or the lack of RT as part of the treatment modalities [17,19,23,24] impossible to statistically predict the longitudinal course of mouth opening of head and neck cancer patients after RT.…”

Section: Introductionmentioning

confidence: 99%

“…Trismus is most likely to develop if RT includes the masticatory muscles and region of the temporomandibular joint, particularly, when RT is combined with chemotherapy, in case of larger tumors, or when trismus is induced by the tumor itself [4,6,10,[15][16][17]. Fibrosis and atrophy of irradiated tissues contribute to trismus, which is likely to develop between 1 month and 1 year post-RT [10,18,19].…”

Section: Introductionmentioning

confidence: 99%

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Mouth opening in patients irradiated for head and neck cancer: A prospective repeated measures study

et al. 2015

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Section: Other Studiesmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mouth opening in patients irradiated for head and neck cancer: A prospective repeated measures study

et al. 2015

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“…The potential risk factors: sex, age, localization of the primary tumor, squamous cell carcinoma, T4 classification, total dose of radiation, fraction dose of radiation, overall treatment time of radiotherapy, surgery, chemotherapy, and maximal mouth opening at previous time point were entered in the model [9,10,[14][15][16]. Thereafter, variables were removed if they did not contribute significantly to the regression equation (p < .05).…”

Section: Statisticsmentioning

confidence: 99%

Predictors for trismus in patients receiving radiotherapy

et al. 2016

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Background: Trismus, a restricted mouth opening in head and neck cancer patients may be caused by tumor infiltration in masticatory muscles, radiation-induced fibrosis or scarring after surgery. It may impede oral functioning severely. The aims of our study were to determine: (1) the incidence of trismus at various time points; and (2) the patient, tumor, and treatment characteristics that predict the development of trismus after radiotherapy in head and neck cancer patients using a large database (n ¼ 641). Methods: Maximal mouth opening was measured prior to and 6, 12, 18, 24, 36, and 48 months after radiotherapy. Patient, tumor, and treatment characteristics were analyzed as potential predictors for trismus using a multivariable logistic regression analysis. Results: At six months after radiotherapy, 28.1% of the patients without trismus prior to radiotherapy developed trismus for the first time. At subsequent time points the incidence declined. Over a total period of 48 months after radiotherapy, the incidence of trismus was 3.6 per 10 person years at risk. Patients who had tumors located in the oral cavity, oropharynx or nasopharynx, and the salivary glands or ear, and who had a longer overall treatment time of radiotherapy, were more likely to develop trismus in the first six months after radiotherapy. Maximal mouth opening was a predictor for developing trismus at all time points. Conclusion: Incidence of trismus is 3.6 per 10 person years at risk. Tumor localization and overall treatment time of radiotherapy are predictors for developing trismus the first six months after radiotherapy. Maximal mouth opening is a significant predictor for developing trismus at all time points. Regular measurements of maximal mouth opening are needed to predict trismus.

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“…13 Our study proves that mouth opening values show statistically significant changes with good patient compliance to physiotherapy (p = 0.02), and the gains that can be made when patients are motivated. Various methods of treatment of trismus that have been reported include use of supportive measures like regular use of muscle relaxants or hot fomentation, hyperbaric oxygen or oral medication such as pentoxiphylline, 17 isometric and range of motion exercises, use of mechanical aids like rubber plugs, wooden tongue blades, spatulas, the TheraBite device, 14,24 and dynamic splinting. Passive exercises had better role in the management and prevention of trismus than active exercises as seen in literature.…”

mentioning

confidence: 99%