Trismus in oral cancer patients undergoing surgery and radiotherapy

Agarwal, Padmanidhi; Kumar, Harsh; Kumar, Kirthi

doi:10.1016/j.jobcr.2016.10.004

Cited by 54 publications

(36 citation statements)

References 21 publications

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“…Radiation therapy uses radioactive elements and high energy radiations produced by X‐ray equipment and particle accelerators that act directly by promoting rupture of the deoxyribonucleic acid chains, or indirectly in the production of free radicals and hydrogen peroxide resulting from the physical action of gamma irradiation in the water, leading to cellular necrosis . During radiation therapy for head and neck cancer, healthy surrounding tissues such as bones, mucosa, teeth, and salivary glands are hardly preserved …”

Section: Introductionmentioning

confidence: 99%

Effect of radiotherapy on the chemical composition of root dentin

et al. 2018

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Background: The radiotherapy can directly affect the bond strength of the adhesive materials, interfering in the prognosis of restorative treatments, which may be caused by chemical changes in dentin structure. Methods: Twenty inferior homologues premolars were distributed in 2 groups (in vitro study) (n = 10): nonirradiated and irradiated. The specimens were submitted to the analysis of phosphate (ν 1 PO 4

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Section: Introductionmentioning

confidence: 99%

Effect of radiotherapy on the chemical composition of root dentin

et al. 2018

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“…However, subjects in this study did not receive any jaw exercise intervention, and the authors concluded that further research was needed to determine the optimal timing of intervention . Agarwal et al found that 86.7% of patients undergoing oral cancer surgery developed trismus immediately post‐surgery (ie, at the time of hospital discharge) . An additional retrospective study examining factors affecting trismus in surgically treated oral cancer patients found that in those with no adjuvant treatment, 28% demonstrated trismus post‐surgery, with a mean time of follow‐up of 21 months …”

Section: Introductionmentioning

confidence: 85%

“…6 Agarwal et al found that 86.7% of patients undergoing oral cancer surgery developed trismus immediately post-surgery (ie, at the time of hospital discharge). 7 An additional retrospective study examining factors affecting trismus in surgically treated oral cancer patients found that in those with no adjuvant treatment, 28% demonstrated trismus post-surgery, with a mean time of follow-up of 21 months. 8 Trismus has been found to be significantly worse in surgical patients who undergo adjuvant (chemo)radiotherapy as compared to surgery alone.…”

Section: Introductionmentioning

confidence: 99%

Effects of jaw exercise intervention timing on outcomes following oral and oropharyngeal cancer surgery: Pilot study

Sandler

Lazarus

et al. 2019

Head & Neck

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Background Common in head and neck cancer patients, trismus can make speech and swallowing difficult and can compromise quality of life (QOL). Jaw range of motion exercise therapy may prevent or treat trismus in surgical patients. While the importance of these exercises is well‐documented, there is little literature regarding the optimal timing of exercise initiation. Methods A prospective pilot study investigated the effects of early vs late jaw exercise intervention on postoperative jaw opening and QOL measures, which were examined descriptively. Results Timing of exercise intervention was not found to significantly impact the measured outcomes. However, provisional, descriptive findings showed that jaw opening was significantly associated with multiple QOL measures, with greater jaw opening associated with improved QOL. For certain QOL measures, this positive association was stronger at earlier time points than at later time points. Conclusions The exploratory findings of this pilot study support further research into possible benefits of early jaw exercise intervention.

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“…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.…”

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 oral cancer patients undergoing surgery and radiotherapy

Cited by 54 publications

References 21 publications

Effect of radiotherapy on the chemical composition of root dentin

Effect of radiotherapy on the chemical composition of root dentin

Effects of jaw exercise intervention timing on outcomes following oral and oropharyngeal cancer surgery: Pilot study

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

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