The role of exercise therapy in managing post-radiotherapy trismus in head and neck cancer

Abstract

Trismus is a post-radiotherapy complication that affects survivors of head and neck cancers. It is described as the reduction of mouth opening to less than 35 mm. The condition is a progressive process; hence early intervention is crucial to prevent further damage and weakness to the elevator muscles of the mandible. Here, we report a 40-year-old woman with known squamous cell carcinoma of the maxillary sinus in stage T3N0M0 who had undergone upper right partial maxillectomy with subsequent 33 fractions of radiotherapy (66 Gy; intensity-modulating radiotherapy). Five months post-radiotherapy, the patient showed interest in replacing her missing teeth to restore her oral functions and facial appearance. At her post-radiotherapy visit in the dental assessment clinic, she showed a mouth opening of 12 mm. The TheraBite® Jaw Motion Rehabilitation System™ and wooden tongue depressors were alternatively used for 6 weeks (4–5 stretches/day; each stretch held for 15 s). Mouth opening gradually increased to 20 mm. Consequently, a definitive obturator prosthesis was fabricated using computer-aided design and computer-aided manufacturing technologies with the 3Shape D900 model scanner. These were challenging and time-consuming steps, but acceptable facial appearance and mouth opening were restored for the patient. This case suggests that Therabite® Jaw Motion Rehabilitation System TM and wooden tongue depressors help to increase mouth opening significantly if used together and alternatively.

Dental considerations for head and neck cancer: A clinical review

“…Another example is the Therabite appliance©, which works in the same way ( Kamstra et al, 2013 ). Using Therabite appliance© and wooden tongue depressors helps to increase mouth opening significantly if used together ( Ezzat et al, 2020 ). On the other hand, some oral surgeons suggest early extraction of posterior teeth if the radiation dose is high and trismus is expected to develop.…”

Atuação Da Fisioterapia No Tratamento Do Trismo Em Pacientes Com Câncer De Cabeça E Pescoço

“…A taxa de mortalidade dos pacientes oncológicos apresenta queda, porém, os efeitos e sequelas dos tratamentos podem ser devastadoras (DAELE et al, 2016). O trismo é uma complicação pós radioterapia possível nos pacientes com câncer de cabeça e pescoço, na qual a abertura da boca é reduzida para menos de 35 mm, e causa alterações na qualidade de vida diária, como dificuldade na alimentação, mastigação, deglutição e cuidados com a higiene bucal (LI et al, 2018;EZZAT et al, 2021). A prevalência de trismo em pacientes com câncer de cabeça e pescoço pode variar de 5 a 38% (KAMSTRA et al, 2013).…”