Trismus following different treatment modalities for head and neck cancer: a systematic review of subjective measures

Abstract

The aim of this review was to compare systematically the subjective measure of trismus between different interventions to treat head and neck cancer, particularly those of the oropharynx. Using The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Guidelines, Six databases were searched for the text using various terms which include “oropharyngeal/head and neck cancer”, “trismus/mouth opening” and the various treatment modalities. Included in the review were clinical studies (> or =10 patients). Three observers independently assessed the papers identified. Among the six studies reviewed, five showed a significantly worst outcome with regard to the quality-of-life questionnaire scores for a radiotherapy or surgery and radiotherapy (RT) ± chemotherapy or chemoradiotherapy when compared to surgery alone. Only one study showed no significant difference between surgery alone and other treatment modalities. Subjective quality-of-life measures are a concurrent part of modern surgical practice. Although subjective measures were utilised to measure post operative trismus successfully, there was no consensus as to which treatment modality had overall better outcomes, with conflicting studies in keeping with the current debate in this field. Larger and higher quality studies are needed to compare all three treatment modalities.

Prevalence of trismus in patients with head and neck cancer: A systematic review with meta‐analysis

“…The heterogeneity of the interventions, outcome measures, and populations made it impossible to conduct a meta‐analysis. Loh et al reported no consensus, based on subjective measures, as to which treatment modality had better outcomes …”

“…Loh et al reported no consensus, based on subjective measures, as to which treatment modality had better outcomes. 20 In 2004, only four studies could be included in a systematic review of prevalence of trismus 24 which concluded that RT reduces the mouth opening by 18% at 6-12 months follow-up. We do agree with Dijkstra et al 24 that studies lack consensus on what constitutes trismus.…”

“…19 Previous reviews have found objective and subjective patient reports of reduced MMO often correlate, however, some patients may continue to complain of trismus while having an MMO within the normal range. [20][21][22] The lack of uniform criteria contributes to the wide range of prevalence presented in previous studies. In addition to the lack of clear diagnostic criteria, there is limited evidence to support clinical guidelines for intervention and treatment.…”

Use of a novel atlas for muscles of mastication to reduce inter observer variability in head and neck radiotherapy contouring

“…Radiation induced trismus is a significant cause of treatment related morbidity [25]. The main application of contouring the masticatory apparatus as an avoidance structure is for tumours not infiltrating the muscles in order to spare normal healthy tissue.…”

Prognostic factors associated with a restricted mouth opening (trismus) in patients with head and neck cancer: Systematic review

“…Diverse patterns were seen over time regarding perceived difficulties with opening the mouth. Patients' perceptions of difficulties with opening the mouth might be influenced by different factors over time, such as pain, dry mouth, overall emotional functioning, or treatment modalities 81,82 …”