Prognostic factors associated with a restricted mouth opening (trismus) in patients with head and neck cancer: Systematic review

Abstract

Background To prescribe early trismus therapy, prognostic factors influencing the restricted mouth opening should be identified first. Our aim is to present an overview of these factors in patients with head and neck cancer. Methods PubMed, Cochrane, EMBASE, and CINAHL were searched using terms related to head and neck cancer and mouth opening. Risk of bias was assessed using the “Quality in Prognosis Studies” tool. A best evidence synthesis was performed. Results Of the identified 1418 studies, 53 were included. Three studies contained a prognostic multivariate model for a restricted mouth opening. Conclusions Patients with head and neck cancer will most likely develop a restricted mouth opening when they have a large tumor near the masticatory muscles that requires extensive cancer treatment. A restricted mouth opening most likely occurs within 6 months after cancer treatment. Further research is necessary on factors related to healing tendency or pain intensity.

Transoral Robotic Surgery for Oral Cancer: Evaluating Surgical Outcomes in the Presence of Trismus

“…Trismus, commonly characterized by restricted mouth opening, is frequently observed in patients with head and neck cancers [ 1 , 2 , 3 , 4 , 5 ]. In Taiwan, this condition is particularly prevalent among those who habitually chew betel quid, a practice known to contribute to oral submucosal fibrosis (OSMF) and oral cancer risk [ 6 , 7 ].…”

Trismus surgery and microsurgical reconstruction after oral cancer treatment

“…Several factors have been associated with increased trismus risk. [3][4][5][6] These include high-stage tumors requiring large resections, oral and oropharyngeal location, tumors involving the mandible/maxilla/cheek, those affecting the masticatory muscles, and patients undergoing multimodality treatment.…”

“…Trismus has been described as a non‐negligible morbidity after head and neck cancer, with up to 23.6%–32.6% 1,2 of the patients presenting these sequelae after treatment, increasing to 65%–73% 2 specifically in oral cancer. Several factors have been associated with increased trismus risk 3–6 . These include high‐stage tumors requiring large resections, oral and oropharyngeal location, tumors involving the mandible/maxilla/cheek, those affecting the masticatory muscles, and patients undergoing multimodality treatment.…”

Reply: Comment on “Trismus surgery and microsurgical reconstruction after oral cancer treatment”

“…Surgical resection, scarring, and postoperative radiation in such areas are risk factors for developing trismus. 1 The insertions of the internal pterygoid and masseter muscles to the mandible or their resection also during a posterior maxillectomy explain why such locations, together with the retromolar trigone, have been described as risk factors for trismus. 2 Our study 3 didn't however show any differences in trismus release surgery and microsurgical reconstruction results depending on the initial tumor location.…”