The use of stretching devices for treatment of trismus in head and neck cancer patients: a randomized controlled trial

Abstract

PurposeTo compare the effects of two stretching devices, the TheraBite® Jaw Motion Rehabilitation System™ and the Dynasplint Trismus System®, on maximal mouth opening in head and neck cancer patients.MethodsPatients were randomly assigned to one of two exercise groups: the TheraBite® Jaw Motion Rehabilitation System™ group or the Dynasplint Trismus System® group. Patients performed stretching exercises for 3 months. During the three study visits, maximal mouth opening was measured and the patients completed questionnaires on mandibular function and quality of life.ResultsIn our study population (n = 27), five patients did not start the exercise protocol, eight patients discontinued exercises, and two patients were lost to follow-up. No significant differences regarding the change in mouth opening between the two devices were found. Patients had an increase in MMO of 3.0 mm (IQR − 2.0; 4.0) using the TheraBite® Jaw Motion Rehabilitation System™ and 1.5 mm (IQR 1.0; 3.0) using the Dynasplint Trismus System®. Exercising with either stretching device was challenging for the patients due to the intensive exercise protocol, pain during the exercises, fitting problems with the stretching device, and overall deterioration of their medical condition.ConclusionsThe effects of the two stretching devices did not differ significantly in our study population. The factors described, influencing the progression of stretching exercises, need to be taken into account when prescribing a similar stretching regimen for trismus in head and neck cancer patients.Trial registrationNTR - Dutch Trial Register number: 5589Electronic supplementary materialThe online version of this article (10.1007/s00520-019-05075-7) contains supplementary material, which is available to authorized users.

Interventions for Trismus in Head and Neck Cancer Patients: A Systematic Review of Randomized Controlled Trials

“…30 They did, however, demonstrate a significant improvement in mouth opening within the entire cohort over the length of the study period, suggesting that more than 1 treatment strategy can be effective. The 4 remaining studies [18][19][20][21] compared rehab devices (eg, TheraBite) to control groups and did not find a significant difference.…”

“…Six RCTs evaluated the effectiveness of a combination of jaw rehabilitation device and exercises. [18][19][20][21][22][23] Intervention periods ranged from 3 to 12 months, exercise frequency ranged from 3 to 5 times per day. All but 1 RCT studied patients in the acute period (<3 months) after treatment with surgery, RT, or CCRT; the other included patients >36 months after cancer treatment.…”

“…The remaining 5 RCTs did not have significant results. [18][19][20][21][22] Their characteristics are described below and in greater detail in Tables 2 and 3: • • Two RCTs compared a jaw rehabilitation device (TheraBite) to a control group that did not perform any exercises at all. 18,20 Neither showed a significant difference in maximal interincisor opening (MIO) 12 months after RT (P = .264 for 1 RCT and unspecified for the other).…”

Oral Submucous Fibrosis: A Review on Biomarkers, Pathogenic Mechanisms, and Treatments

“…Mouth exercising devices can significantly improve the mouth opening by approximately 10.5 mm and maintain these results for 12 weeks to 6 months [ 158 ]. Other commercially available devices such as TheraBite ® , Malmö, Sweden Jaw Motion, Rehabilitation System™ (TheraBite), and Dynasplint Trismus System ® (DTS), have been reported to increase mouth opening up to 14 mm [ 159 ]. EZBite designed by Li et al in 2019, provides users a clear and simple protocol and continuously trains patients to open their mouths to a certain quantitative value each time to achieve maximal interincisal opening from 15.7 to 29.7 mm [ 156 , 160 ].…”

“…Self-motivation can increase by using biofeedback app, which tracks changes in patients and increases their motivation [ 166 ]. While patients choose using mouth exercising devices, the intensive exercise protocol and fitting problems between the patient and the devices must be evaluated first [ 159 ]. It can be constructed by 3D printing technology, oral scanning equipment, and CT images to provide a customized instrument.…”