Maximum mouth opening and trismus in 143 patients treated for oral cancer: A 1‐year prospective study

Wetzels, Jan‐Willem G. H.; Merkx, M.A.W.; Haan, A.F.J. de; Koole, R.; Speksnijder, Caroline M.

doi:10.1002/hed.23534

Cited by 67 publications

(142 citation statements)

References 38 publications

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“…At the end of radiotherapy, a reduction of the MMO was observed in all study patients, as it was reported by others, too [12]. Trismus was observed in 3 of 8 patients (37.5%), while the mean MMO in all patients was below the limit of trismus.…”

Section: Discussion Trismussupporting

confidence: 86%

“…The absence of specific criteria for the definition of trismus and the non-homogeneous group of patients in the different studies are also some of the main reasons for the above wide variation of the prevalence of trismus in head and neck cancer patients [6,9,12,13].…”

Section: Discussion Trismusmentioning

confidence: 99%

“…The type of therapy was not the same among the patients. Sixty-four of all 143 patients received post-operative radiotherapy [12].…”

Section: Discussion Trismusmentioning

confidence: 99%

“…The risk for trismus is also increased when the masticator and lateral pterygoid muscles are included in the radiation field, in patients with advanced stage of disease, and with chemoradiotherapy [6,9−11]. Furthermore, patients with oral carcinoma, who receive post-operative radiotherapy have increased risk for trismus, which is related to the fibrosis of masticator muscles due to radiotherapy and due to fibrosis related to the surgical management of tumour [10,12,13].…”

Section: Introductionmentioning

confidence: 99%

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Trismus and reduced quality of life in patients with oral squamous cell carcinoma, who received post-operative radiotherapy alone or combined with chemotherapy

Galitis

Droukas

Tzakis

et al. 2017

Forum of Clinical Oncology

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Background Patients, who receive radiotherapy (RT) for head and neck cancer, develop chronic functional abnormalities and survive with reduced quality of life. Purpose We aimed to study patients with oral cancer, who received post-operative radiotherapy or chemoradiotherapy. Patients Ten patients (mean age 63.8 years) were included. Methods Oral mucositis, pain and xerostomia, maximum mouth opening (MMO) and functional abnormalities before and after RT were recorded. The 35 mm MMO or less was accepted as trismus. Patients completed the EORTC QLQ C-30 and Head/Neck35 questionnaires. Results Mean RT dose was 64.3 Gray. Six patients received chemoradiotherapy. Severe mucositis, pain and xerostomia were recorded in 6 and 5 patients respectively. MMO was reduced in all patients. The mean MMO (34 mm) reached the level of trismus. The total number of symptoms increased from 3.1 to 6.3 in C-30 and from 3.1 to 8.8 per patient in the H/N35. Severe fatigue, pain, limitations at work, weakness, sad feelings, family problems, sleeping problems, anorexia, financial difficulties, tense/irritable, constipation, nausea, vomiting and depression were most often reported with C-30. Most patients reported low to moderate quality of life. Severe oral, jaw and neck pain, swallowing problems, taste alterations, sticky saliva, dry mouth, coarseness, dental problems, feeling sick and reduced interest in life/sex were the most common symptoms reported with N/H35. Conclusions The observed trismus, 2- to 3-fold increase of symptoms and poorer quality of life highlighted the need for support of oral cancer patients, who receive postoperative radiotherapy or chemoradiotherapy.

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Section: Discussion Trismussupporting

confidence: 86%

Section: Discussion Trismusmentioning

confidence: 99%

“…The type of therapy was not the same among the patients. Sixty-four of all 143 patients received post-operative radiotherapy [12].…”

Section: Discussion Trismusmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Trismus and reduced quality of life in patients with oral squamous cell carcinoma, who received post-operative radiotherapy alone or combined with chemotherapy

Galitis

Droukas

Tzakis

et al. 2017

Forum of Clinical Oncology

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“…As found in other studies, the mean age of the sample was over 60 years 5,[8][9][10] , the dominant sex is male and the location most affected by tumors is the tongue 5,[7][8] .…”

Section: Discussionmentioning

confidence: 51%

Limitation of mouth opening after radiotherapy for head and neck

Caetano

Castro²,

Castro³

et al. 2016

RGO, Rev. Gaúch. Odontol.

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Objective To evaluate the ability to open the mouth in patients undergoing radiotherapy for head and neck and the variables related to this limitation. Methods patients were evaluated six months after completion of radiotherapy sessions to treat cancer in the head RESUMOObjetivo Avaliar a capacidade de abertura bucal de pacientes submetidos a tratamento radioterápico de cabeça e as variáveis relacionadas à sua limitação. MétodosForam analisados 32 pacientes seis meses após o término das sessões de radioterapia para tratamento de câncer em região de cabeça e pescoço. A medida da abertura bucal máxima foi aferida por meio de um paquímetro digital e sua associação com as variáveis sexo, idade, tabagismo, etilismo, localização do tumor, realização de quimioterapia e cirurgia foram analisadas com os testes U de Mann-Whitney e KruskalWallis no nível de significância de 95%. ResultadosA idade média dos pacientes foi de 60,44 anos; 87,5% eram do sexo masculino; 81,2% eram tabagistas; 65,6% eram etilistas. A média de abertura bucal foi de 43,17mm e sete pacientes (21,9%) apresentavam trismo. As localizações mais frequentes dos tumores foi a língua (31,3%), seguida da laringe e da prega vocal com cinco (15,6%) cada uma. Não foi encontrada associação entre a limitação de abertura bucal e as variáveis estudadas. ConclusãoNa amostra estudada, 21,9% dos pacientes apresentaram trismo seis meses após o término do tratamento radioterápico. As variáveis sexo, hábitos de etilismo e tabagismo, localização do tumor, cirurgia prévia e quimioterapia adjuvante não estiveram associados à limitação de abertura bucal.Termos de indexação: Neoplasias de cabeça e pescoço. Boca. Radioterapia. Limitation of mouth opening after radiotherapy for head and neck Limitação de abertura bucal pós-radioterapia de cabeça e pescoço 25Limitation of mouth opening after radiotherapy for head and neck collected in respect of age, the social habits of smoking and alcohol consumption, tumor location, performance of adjunctive treatment (chemotherapy and/or surgery) and the measurement of the mouth opening.The mouth opening capacity was checked using digital calipers (Pantec -São Paulo, Brazil). In those patients who still have their teeth, the distance was measured between the incisal edge of the upper and lower incisors (11, 41); patients with an edentulous lower arch and without the use of a prosthesis, the distance between the incisal edge of tooth 11 and the lower alveolar ridge (region of tooth 41); patients with an edentulous upper arch and without the use of a prosthesis, the distance between the incisal edge of tooth 41 and the alveolar ridge (region of tooth 11); edentulous patients using prostheses, the distance between the upper and lower dentures was measured, or if the patient had no prosthesis, the maximum distance between the two alveolar ridges (location of teeth 11 and 41) was measured, as described by Dijkstra et al. 7 A patient was deemed to be suffering from trismus when his/her maximum mouth opening was less than 35 mm 7 .The dat...

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Temporomandibular disorder as risk factor for radiation‐induced trismus in patients with head and neck cancer

Pauli

Mohlin

Mejersjö

et al. 2021

Clinical & Exp Dental Res

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Objectives The aim of this study was to investigate if patients with temporomandibular disorders (TMD) prior to head and neck cancer (HNC) treatment are at higher risk of developing trismus after oncological treatment. Materials and Methods Eighty‐three study patients underwent detailed dental examination prior oncological treatment and 6 months after radiotherapy completion, including evaluation of temporomandibular jaw function, palpation of the jaw muscles, and measurement of mouth opening capacity. TMD criteria were based on both clinical examination findings and patient‐reported symptoms. TMD at baseline was used in regression analysis in order to predict restricted mouth opening. Results At the 6 months follow‐up more than a third of the patients (35%) were examined with reduced mouth opening of >20% compared to baseline. A majority of the patients had bilateral tenderness of both the temporal and the masseter muscle. At the 6 months follow‐up, 42% of the study patients reported mouth opening problems. About one‐third of the patients suffered from fatigue and stiffness of the jaw as well as pain when mowing the jaw. Two questions from the validated symptom‐specific Gothenburg Trismus Questionnaire were found to be related to a statistically significant increased risk of restricted mouth opening after radiotherapy; “During the last week, have you felt: Pain on moving the jaw?” (OR [95% CI] 5.9 (1.2–29.4) [p = 0.030]) and “During the last week, have you felt pain and tenderness in the muscles of mastication?” (OR [95% CI] 5.90 [1.19–29.40] [p = 0.030]). Conclusions TMD is common amongst HNC patients. Patients who suffer from pain in the jaw muscles and pain when moving the jaw before start of treatment are at higher risk of radiation‐induced trismus after 6 months. Clinicians should strive for optimizing the patients pain treatment and oral health before, during, and after radiotherapy.

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Maximum mouth opening and trismus in 143 patients treated for oral cancer: A 1‐year prospective study

Abstract: Postoperative radiotherapy and maxillary or mandibular tumor involvement are the highest contributing risk factors to decreasing MMO and the subsequent development of trismus after oral cancer treatment.

Cited by 67 publications

References 38 publications

Trismus and reduced quality of life in patients with oral squamous cell carcinoma, who received post-operative radiotherapy alone or combined with chemotherapy

Trismus and reduced quality of life in patients with oral squamous cell carcinoma, who received post-operative radiotherapy alone or combined with chemotherapy

Limitation of mouth opening after radiotherapy for head and neck

Temporomandibular disorder as risk factor for radiation‐induced trismus in patients with head and neck cancer

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