TheraBite exercises to treat trismus secondary to head and neck cancer

Abstract

PurposeThe aim of this study was to evaluate the effect of TheraBite exercises on mouth opening and to analyze factors influencing this effect in a patient record evaluation.MethodsEffect of exercises with a TheraBite to treat trismus was evaluated in 69 head and neck cancer patients of two university medical centers. Mouth opening was measured as interincisal distance in millimeters. Patient, tumor, and treatment characteristics were analyzed for their relationship with change in mouth opening. Variables univariately associated (p ≤ 0.05) with change in mouth opening were entered in a logistic regression analysis as possible predictors for an increase in mouth opening of the smallest detectable difference of 5 mm or more.ResultsMean initial mouth opening was 22.0 mm (SD 6.4); mean increase in mouth opening was 5.4 mm (SD 5.7). “Chemotherapy”, “medical center”, and “time from oncological treatment to start exercises” were significantly associated with an increase in mouth opening. In the logistic regression analysis, “medical center” (β = 1.97) and “time from oncological treatment to start exercises” reduced the odds of reaching an increase in mouth opening of 5 mm or more, β = −0.11 per month.ConclusionsAfter TheraBite exercises, mouth opening increased averagely with 5.4 mm. The odds of an increase in mouth opening of 5 mm or more reduces if the time from oncological treatment to start exercises lengthens, corrected for the effect of medical center.

Mouth opening in patients irradiated for head and neck cancer: A prospective repeated measures study

“…For example, patients who perform exercises during RT experience a smaller decrease in mouth opening compared to those who do not exercise [16,26,27]. Additionally, a larger increase in mouth opening is expected when exercises are started early [28]. However, such preventive programs can be a burden to patients, especially during the course of RT.…”

Radiation-induced fibrosis: mechanisms and implications for therapy

“…For example, physiotherapy has been shown to be effective in reducing lymphedema and preserving shoulder motion post-radiation in patients with breast cancer, and the LPG Systems mechanical massage technique has been shown to reduce RIF in breast cutaneous tissue (Bourgeois et al 2008; Box et al 2002). For patients with head and neck cancer that have trismus post-radiation, progressive increases in mouth opening using tongue blades, the Dynasplint Trismus System, or the TheraBite Jaw Motion Rehabilitation System have been recommended (Baranano et al 2011; Grandi et al 2007; Kamstra et al 2013; Melchers et al 2009; Sciubba and Goldenberg 2006; Shulman et al 2008; Stubblefield et al 2010). Coronoidectomy has been shown to be efficacious in refractory cases (Bhrany et al 2007), although careful thought and consideration must be given to this intervention as surgery may lead to even greater fibrosis.…”

Developing a New Appliance to Dissipate Mechanical Load on Teeth and Improve Limitation of Vertical Mouth Opening

“…The combination of leverage and hinge movements enabled the shellshaped mouth opening appliance to adapt to complex mandibular movements, and the mouth pads helped to evenly distribute the mechanical stress and torque. In this regard, the shell-shaped mouth opening appliance may be superior in reducing the overconcentration of particular tooth during the treatment of limitation of mouth opening, which is paramount for patient compliance and positive therapy outcomes [16] and contribute to avoid the fracture of a titanium reconstruction plates [10]. However, to confirm whether the shell-shaped mouth opening appliance is superior to the TheraBite ® appliance, further research need to compare the TheraBite ® appliance and the shell-shaped mouth opening appliance and to establish the best way to use the shell-shaped mouth opening appliance for the treatment of limitation of opening in vivo study.…”

“…Other group implied that use of the TheraBite ® appliance results in pain because of the consequent rebounding spasms of the masticatory muscles [4] and this is because the TheraBite ® appliance is a high-torque appliance that provides a short-duration passive stretch [4]. In some cases, the fracture of a titanium reconstruction plates during the TheraBite ® appliance exercises is an adverse effect that can be explained by non-union of the fibula to the mandible, by the recurrence of carcinoma, or by excessive stretching forces [10]. When prescribing exercises with the TheraBite ® appliance in cases of bony reconstructions of the mandible, exercise forces should be limited until consolidation of the reconstruction is completed [10].…”

“…In some cases, the fracture of a titanium reconstruction plates during the TheraBite ® appliance exercises is an adverse effect that can be explained by non-union of the fibula to the mandible, by the recurrence of carcinoma, or by excessive stretching forces [10]. When prescribing exercises with the TheraBite ® appliance in cases of bony reconstructions of the mandible, exercise forces should be limited until consolidation of the reconstruction is completed [10]. However, it was not previously reported how the high-torque using by the TheraBite ® appliance affected the pressure balance to teeth.…”