The incidence of trismus and long-term impact on health-related quality of life in patients with head and neck cancer

Abstract

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.

Trismus in oral cancer patients undergoing surgery and radiotherapy

“…There is also evidence that trismus evolves most rapidly during the first 9 months after treatment and then stops progressing in most patients. 5 A statistical significance was observed in the time of undergoing RT. 73% (11/15) of patients who underwent RT early and 100% (12/12) patients who underwent RT late ended up with trismus.…”

“…Immobilization of the TMJ after surgery for long also has been shown to compound the problem. 5 Our patients with lesions of the buccal mucosa, maxilla and RMT region developed trismus more. Cancers in such regions are known to trigger reflexes in the maxillofacial area, activate the efferent part of the tonic reflex arch of the muscles of mastication resulting is an increased tonus, developing trismus.…”

“…It has been vastly reported that the irradiation of the masseter and pterygoid muscles appears critical in the development of trismus. 5,22 Irradiation of the pterygoids alone has been found to induce trismus due to the late tissue reaction called radiation induced fibro atrophic activity. 23 The T allele at 509 of the TGF b1 gene has shown significant variation in mouth opening and has been suggested as a genetic link in the development of post-radiation trismus.…”

Risk structures for radiation-induced trismus in head and neck cancer

“…Amongst the late appearing side effects after radiotherapy (RT) for HNC, restricted mouth opening (trismus) occurs in more than one third of patients and have been described as persisting or even worsening five years after completed RT [1][2][3]. Trismus can lead to difficulties in eating, chewing, maintaining oral hygiene, and potentially to malnutrition and weight loss [2][3][4][5][6].…”

“…Ewing's sarcoma (ES) accounts for about 3% of all pediatric and adolescent malignancies and remains the second most common primary bone tumor [3]. Following the introduction of combined modality treatment, the prognosis has dramatically improved with an expected survival of 70-80% for patients presenting with localized disease [4].…”