Trismus in head and neck oncology: a systematic review

Dijkstra, Pieter U.; Kalk, W.; Roodenburg, Jan

doi:10.1016/j.oraloncology.2004.04.003

Cited by 222 publications

(176 citation statements)

References 26 publications

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“…Dijkstra et al [18] documented that, the eVects of therapeutic interventions of trismus are hardly investigated and evidence supporting prevention and treatment programs is generally not provided. Nevertheless, one randomised trial in patients who had undergone radiotherapy for cancer of the head and neck showed that standard stretching exercises with or without the use of tongue depressors, and exercises with the passive jaw moving device TheraBite, did increase mouth opening signiWcantly [106].…”

Section: Future Directionsmentioning

confidence: 99%

“…Rehabilitation that prevents and/or alleviates the loss of function and increases the patients' quality of life therefore seems necessary. Several speciWc swallowing exercises have the potential to improve prognosis for oral intake (e.g., jaw exercises [18], swallowing exercises [19] and maneuvres) [17,20,21]. It is, however, unknown whether these standard exercises have a preventative eVect in patients receiving CRT and whether the eVects, if any, are maintained long-term.…”

Section: Introductionmentioning

confidence: 99%

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Functional outcomes and rehabilitation strategies in patients treated with chemoradiotherapy for advanced head and neck cancer: a systematic review

Molen

Rossum

Burkhead

et al. 2008

Eur Arch Otorhinolaryngol

109

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Organ preservation with radiotherapy and concomitant chemotherapy has become an accepted treatment modality in advanced head and neck cancer. Unfortunately, organ preservation is not synonymous with function preservation. The aim of this review was to systematically assess the eVects of the disease and chemoradiotherapy (CRT) on functions such as swallowing, mouth opening, nutrition, pain and quality of life in patients with head and neck cancer. Another aim was to search for (evidence-based) techniques or strategies known to alleviate or rehabilitate the loss of function(s) associated with CRT. Two databases were searched (time period, January 1997 to August 2007) for the terms head and neck cancer, chemotherapy or cisplatin and radiotherapy, and the functional outcomes swallowing, trismus, nutrition, pain and quality of life or a variation of those words. In total, 15 relevant articles were identiWed that met the inclusion criteria. The majority of the studies that met the criteria focused on the outcomes swallowing, quality of life, and nutrition. Two studies reported on the outcome pain, but no paper reported on the outcome trismus. Only two papers mentioned rehabilitation options, but speciWc information was lacking. Further long-term prospective research is essential, not only to determine the function impairment caused by the tumor and CRT, but also to assess the eVects of known and newly developed rehabilitation measures. Therefore, in September 2006, the Netherlands Cancer Institute started a randomised clinical trial (RCT): Prevention of trismus, swallowing and speech problems in patients treated with chemoradiotherapy for advanced head and neck cancer. This systematic review was carried out to collect the baseline information for the future outcomes of this RCT.

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Section: Future Directionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Functional outcomes and rehabilitation strategies in patients treated with chemoradiotherapy for advanced head and neck cancer: a systematic review

Molen

Rossum

Burkhead

et al. 2008

Eur Arch Otorhinolaryngol

109

View full text Add to dashboard Cite

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“…The prevalence of trismus has been reported to be from 5% to 38% after treatment for head and neck malignancies. 4 Trismus may result from a variety of conditions, such as trauma, tumours, infections, surgery, and radiotherapy involving the mandible, maxilla, temporomandibular joint, muscles of mastication, oral cavity, teeth, and pharynx. Severe trismus that is secondary to masseter muscle rigidity associated with malignant hyperthermia and neuroleptic malignant syndrome is rare but potentially life-threatening.…”

Section: Discussionmentioning

confidence: 99%

Retromolar fibreoptic orotracheal intubation in a patient with severe trismus undergoing nasal surgery

Truong

2011

Can J Anesth/J Can Anesth

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Purpose A considerable challenge arises when passage of an endotracheal tube between the teeth is impossible because of severe trismus and the presence of concomitant contraindications to nasotracheal intubation. We report a novel technique to circumvent the need for tracheostomy by using the retromolar space for oral fibreoptic intubation. Clinical features A 50-yr-old female with a history of pharyngeal cancers treated with surgery and radiotherapy presented for right dacryocystorhinostomy. She had undergone left dacryocystorhinostomy after nasotracheal intubation one week earlier. This time, orotracheal intubation was requested since surgery would involve the right nostril and left nasal intubation might dislodge the recently placed nasolacrimal tube. Due to severe trismus, the patient's interincisor distance was only 9 mm, and it was impossible to pass a 6.0 mm endotracheal tube through that gap. A flexible bronchoscope loaded with a 6.0 mm tracheal tube was inserted through the retromolar space into the pharynx and maneuvered through the vocal cords for endotracheal intubation. Conclusions The retromolar space is located between the last molar and the ascending ramus of the mandible. Even with complete mandibular occlusion, it is usually able to accommodate a 7.0 mm endotracheal tube. Despite its hidden location, it can be used successfully for orotracheal fibreoptic intubation. With practice, the expertise achieved in performing this technique will confer a much needed option for securing the airway in this challenging situation. RésuméObjectif Un de´fi de taille surgit lors le passage d'une sonde endotrache´ale entre les dents est impossible en raison d'un trismus grave et de la pre´sence de contre-indications concomitantes a`l'intubation nasotrache´ale. Nous rapportons une technique innovante pour contourner le recours a`une trache´ostomie en utilisant l'espace re´tromolaire pour re´aliser une intubation orale par fibroscopie. É léments cliniques Une femme de 50 ans, avec des ante´ce´dents de cancers du pharynx traite´s par chirurgie et radiothe´rapie, s'est pre´sente´e pour subir une dacryocystorhinostomie droite. Elle avait de´ja`subi une dacryocystorhinostomie gauche apre`s une intubation nasotrache´ale la semaine pre´ce´dente. Cette fois-ci, une intubation orotrache´ale e´tait requise e´tant donne´que la chirurgie serait situe´e a`la narine droite et qu'une intubation nasale gauche pourrait de´loger le tube lacrymo-nasal. En raison d'un trismus grave, la distance entre les incisives de la patiente n'e´tait que de 9 mm, et il e´tait impossible de passer une sonde endotrache´ale de 6,0 mm dans cet espace. Un bronchoscope flexible charge´d'une sonde trache´ale de 6,0 mm a e´te´inse´re´via l'espace re´tromolaire dans le pharynx et dirige´entre les cordes vocales pour re´aliser une intubation endotrache´ale. Conclusion L'espace re´tromolaire est situe´entre la dernie`re molaire et le rameau ascendant de la mandibule. Meˆme dans les cas d'occlusion mandibulaire comple`te, cet espace peut en ge´ne´r...

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“…Trismus is defined as a tonic contraction of the muscles of mastication with mouth opening of ≤ 35 mm 1 . It can result in difficulty in activities such as biting, chewing, swallowing and speaking and may further lead to poor oral hygiene, pain and weight loss 2 .…”

Section: Dear Editormentioning

confidence: 99%

Trismus secondary to valproate treatment in a woman with bipolar disorder: a case report

Bermudez

Gracia

Garcia

et al. 2017

Arch. Clin. Psychiatry (São Paulo)

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Muscle contracture is a common symptom of valproate. However, there is no report in the literature of lockjaw (trismus) associated with this drug. We therefore present a case of lockjaw during valproate treatment in a patient with bipolar disorder and hypoparathyroidism.A 62-year-old Caucasian female was admitted on November, 2015 at a psychiatric unit during a manic episode. Patient was previously diagnosed with bipolar disorder and had manic and depressive episodes in the past. She underwent a total thyroidectomy three months prior to her admission, for suspicion of malignancy (not confirmed by biopsy) and has been since then in treatment for hypothyroidism and iatrogenic hypoparathyroidism with levothyroxine, calcitriol and calcium carbonate. She had no cognitive impairment and no relevant findings in laboratory exams. A cerebral perfusion scintigraphy was performed showing slight hypoperfusion in the frontal lobe and posterior cerebellar areas. It is noteworthy that the patient did not tolerate lithium carbonate due to severe extremity tremors. Therefore, valproate was initiated and gradually increased up to 1000 mg/day. She developed lockjaw three days after. She was unable to open her mouth and also fractured two teeth. She had difficulty in diction and in chewing food. No painful symptom or other muscular manifestation had been reported. Biperiden and clonazepam were prescribed without response. She had no prior symptoms of muscular spasm and she denied previous use of valproate. The diagnosis of valproate-induced trismus was made after other causes of trismus, such as infections, neurological illness and oro-dental abnormalities were excluded. The laboratory tests show no alterations on serum levels of TSH, PTH, phosphate and calcium. Thus, the valproate was replaced by olanzapine, which lead to symptom resolution. Patient has been in follow-up for two years and did not have any trismus symptoms since valproic acid withdrawal.Trismus is defined as a tonic contraction of the muscles of mastication with mouth opening of ≤ 35 mm 1 . It can result in difficulty in activities such as biting, chewing, swallowing and speaking and may further lead to poor oral hygiene, pain and weight loss 2 . Some of the causal factors implicated in this condition are tumors, infections, surgery and radiotherapy complications, and drugs side effect 3 . There are case reports of trismus induced by succinylcholine 4 and duloxetine 5 , but none regarding this side effect with valproate. A recent systematic review of the untoward effects of valproate showed that drug-induced parkinsonism is a relatively common side effect in elderly women 6 . It's known that valproate can safely be used in patients with thyroid and parathyroid dysfunction, once it does not interfere on these hormone levels 7 . The mechanism of how valproate can induce trismus is unclear. A preclinical study found that low concentrations of valproate can induce muscle contractions, which were abolished by indomethacin.8 Therefore, prostaglandins may be implicated in...

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Trismus in head and neck oncology: a systematic review

Cited by 222 publications

References 26 publications

Functional outcomes and rehabilitation strategies in patients treated with chemoradiotherapy for advanced head and neck cancer: a systematic review

Functional outcomes and rehabilitation strategies in patients treated with chemoradiotherapy for advanced head and neck cancer: a systematic review

Retromolar fibreoptic orotracheal intubation in a patient with severe trismus undergoing nasal surgery

Trismus secondary to valproate treatment in a woman with bipolar disorder: a case report

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