The progress of post-treatment restricted mouth opening in oral and maxillofacial malignant tumor patients

Abstract

Oral and maxillofacial malignant tumor seriously threaten the physical and mental health of patients, especially advanced malignant tumor requiring a comprehensive sequence of surgery-based treatment, resulting in facial deformity, difficulties with chewing, dysphagia and asophia. Among them, trismus (restricted mouth opening) is one of the most common complications after treatment of oral and maxillofacial malignant tumor. In severe cases, they may even suffer from trismus and eating difficulties, finally leading to malnutrition and even cachexia. Therefore, it not only affects the quality of life of the patients and even endangers their lives, but also brings heavy social and economic burden. How to effectively prevent and treat posttreatment trismus is a clinical problem which is easy to be ignored by oral and maxillofacial surgeons and needs to be solved urgently. In recent years, restricted mouth opening (trismus) after post-treatment of oropharyngeal, nasopharyngeal and other head and neck malignant tumors have been widely studied, but restricted mouth opening after comprehensive treatment of oral cancer has been neglected. We therefore conducted a systematic review with 3 aims: (I) to clear the definition of restricted mouth opening and trismus; (II) to identify epidemiology and pathogenesis of restricted mouth opening or trismus; and (III) to summarize the methods of interventions or treatment of oral and maxillofacial malignant tumor patients with restricted mouth opening or trismus.

Challenges in Managing Post-Radiation TMJ Pseudoankylosis

“…In maxillofacial tumor patients, the pathogenesis of trismus is multifactorial 2 . First of all, in this case, normal mastication function was lost because of maxillary resection.…”

“…Definitive maxillary reconstruction was delayed for 1 year, causing chronic hypomobility, which resulted in hypotrophy of the masticatory muscles. Secondly, secondary healing of the patient’s initial tumor resection yields contraction and fibrosis from tissue adhesion and surgical scar formation 2 . Finally, radiation therapy caused radiation-induced fibrosis (RIF), promoting progressive limitation in mouth opening.…”

Developing and Validating an Intelligent Mouth-Opening Training Device: A New Solution for Restricted Mouth Opening

“…Methods to alleviate RMO include medication, modified radiotherapy techniques, or surgical intervention. Surgical intervention may be necessary for patients with severe or prolonged RMO [ 17 ], but surgical removal of some tissue structures may cause other complications. Therefore, the current strategy focuses on prevention, preventing the deterioration of RMO, and restoring oral function through conservative treatment as much as possible.…”

“…Passive exercises involving jawbone movements have been widely acknowledged as effective rehabilitation techniques, encompassing guided finger training methods, wedge occlusal pad training methods, and traditional mouth-opening trainers. Regardless of the method used, the effectiveness of mouth-opening exercises largely depends on the patient’s compliance [ 17 ]. Additionally, during the patient’s home training, incorrect utilization of the mouth-opening device or the use of sudden force may result in TMJ injury, consequently exacerbating the degree of RMO.…”