Prophylactic training for the prevention of radiotherapy-induced trismus – a randomised study

Abstract

Background. Radiotherapy-induced trismus (RTIT) is a debilitating condition without any proven effective treatment. This study investigates the effectiveness of prophylactic training to prevent RTIT during and up to 12 months after completed RT in patients with head and neck cancer (HNC), also investigating the incidence of RTIT. Methods. Sixty-six consecutive patients from two RT clinics in Sweden were randomised into one of two groups: training with TheraBite ® Jaw Motion Rehabilitation System ™ or a control group. Maximum interincisal openings (MIO) were recorded at baseline and once a week during treatment, three, six and 12 months after completed RT. Training frequency was recorded by patients in a log book. Results. There were no signifi cant differences in MIO between the intervention and control groups at any of the measurement points. Patients in both groups maintained their normal variation in MIO at 12 months after completed RT. A small group of patients in the control group had a 17% mean decrease in MIO by week 6 compared to baseline and improved their MIO by using the training programme. There was a signifi cant mean difference in MIO from baseline to week 6 (3 mm, p ϭ 0.018), and month 6 (2.7 mm, p ϭ 0.040), for patients receiving 3D conformal radiotherapy. There was a signifi cant difference in MIO between patients treated with RT and concurrent chemotherapy compared to patients with RT only at 12 months (p ϭ 0.033). Conclusions. Patients with HNC undergoing high dose RT do not need to be burdened with an intense prophylactic training programme during RT and up to 12 months after completed RT. MIO measurements during RT and up to 12 months after completed RT are recommended to identify a small risk group who are an exception and may need a training programme.

Exercise therapy for trismus secondary to head and neck cancer: A systematic review

“…Eight studies analyzed the effects of preventive measures on mouth opening, including with the TheraBite, active range of motion exercises (with or without chewing gum), and wooden tongue depressors …”

“…All studies reported the sample size, age, and sex of the participants, and premeasurements and postmeasurements of mouth opening. The risk of bias assessment that was performed for the included RCTs showed that many items were unclear (Table ). The criteria “overall incomplete data addressed” and “free of selective outcome reporting” were predominantly scored “yes.”…”

Objective assessment of trismus in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT)

“…Prophylactic and immediate conservative management of trismus has been shown to be effective in some patients (Loorents et al, 2014; Cohen et al, 2005). The use of exercise therapy and jaw opening devices such as stacked tongue depressors, corkscrews, TheraBite and Dynasplint devices are routinely employed.…”

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

“…Thus far, few studies have evaluated the effect of prophylactic exercise therapy on the development of trismus [32][33][34]. Considering the importance of the abovementioned aspect of time, prophylactic exercise therapy, starting before or during radiation treatment, might also be valuable.…”

“…Considering the importance of the abovementioned aspect of time, prophylactic exercise therapy, starting before or during radiation treatment, might also be valuable. Loorents et al [33] have indicated that prophylactic therapy is beneficial in only a small group of patients, being at risk for developing trismus. Two of these have demonstrated that jaw exercises can be useful in reducing [32] or preventing [34] the extent or severity of various side effects of radiotherapy-induced trismus.…”