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Charters E, Loy J, Cheng K, Dunn M, Manzie T, Wan B, Tumuluri V, Clark JR. What is the force required to treat trismus in patients undergoing oral cavity free flap reconstruction? Head Neck 2024. [PMID: 39031832 DOI: 10.1002/hed.27850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Trismus therapy is often delayed after jaw reconstruction to avoid hardware failure or non-union. The aim of this study is to document the forces that have been applied to patients undergoing free flap reconstruction of the oral cavity in the 12 months following oral cavity reconstruction, and to analyze the associations between force and maximal interincisal opening (MIO) over time. METHODS Participants with trismus after free flap reconstruction of the oral cavity completed a 10-week jaw stretching program using Restorabite™. Primary outcome measures included the minimum and maximal force applied by a trismus device during rehabilitation, MIO, bone union, and health-related quality of life outcomes up to 12 months postoperatively. RESULTS A mean of 20.6 Newtons (N) was used during passive exercises and 38.9 N during active exercises was used during trismus therapy. The mean increase in MIO for the 45 participants after 10 weeks, 6 months, and 12 months of therapy was 8.4 mm (p < 0.001), 12.6 mm (p < 0.001), 12.7 mm (p < 0.001), respectively. There was no significant difference in the mean minimal (p = 0.37) or mean maximal (p = 0.08) force applied between those who underwent osseous free flap reconstruction compared to fasciocutaneous only, respectively. In patients who underwent osseous reconstruction, 25 (67.6%) had complete bone union and 12 (32.4%) had partial union at 12 months postsurgery. CONCLUSIONS In participants undergoing osseous free flap reconstruction, there was no association between the force applied to the rates of bone union. Further research to define safe and optimal loading may benefit patients undergoing jaw reconstruction.
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Affiliation(s)
- Emma Charters
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jamie Loy
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Kai Cheng
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Masako Dunn
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy Manzie
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Boyang Wan
- School of Aerospace, Mechanical and Mechatronic Engineering, Faculty of Engineering, The University of Sydney, Sydney, New South Wales, Australia
| | - Vinay Tumuluri
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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Maoz SL, Golzar A, Choby G, Hwang PH, Wang EW, Kuan EC, Adappa ND, Geltzeiler M, Getz AE, Humphreys IM, Le CH, Pinheiro-Neto CD, Fischer JL, Chan EP, Abuzeid WM, Chang EH, Jafari A, Kingdom TT, Kohanski MA, Lee JK, Lazor JW, Nabavizadeh A, Nayak JV, Palmer JN, Patel ZM, Resnick AC, Smith TL, Snyderman CH, St John MA, Storm PB, Suh JD, Wang MB, Sim MS, Beswick DM. University of Washington Quality of Life subdomain outcomes after treatment of sinonasal malignancy: A prospective, multicenter study. Int Forum Allergy Rhinol 2024. [PMID: 38884276 DOI: 10.1002/alr.23386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/30/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Sinonasal malignancies (SNMs) adversely impact patients' quality of life (QOL) and are frequently identified at an advanced stage. Because these tumors are rare, there are few studies that examine the specific QOL areas that are impacted. This knowledge would help improve the care of these patients. METHODS In this prospective, multi-institutional study, 273 patients with SNMs who underwent definitive treatment with curative intent were evaluated. We used the University of Washington Quality of Life (UWQOL) instrument over 5 years from diagnosis to identify demographic, treatment, and disease-related factors that influence each of the 12 UWQOL subdomains from baseline to 5 -years post-treatment. RESULTS Multivariate models found endoscopic resection predicted improved pain (vs. nonsurgical treatment CI 2.4, 19.4, p = 0.01) and appearance versus open (CI 27.0, 35.0, p < 0.001) or combined (CI 10.4, 17.1, p < 0.001). Pterygopalatine fossa involvement predicted worse swallow (CI -10.8, -2.4, p = 0.01) and pain (CI -17.0, -4.0, p < 0.001). Neck dissection predicted worse swallow (CI -14.8, -2.8, p < 0.001), taste (CI -31.7, -1.5, p = 0.02), and salivary symptoms (CI -28.4, -8.6, p < 0.001). Maxillary involvement predicted worse chewing (CI 9.8, 33.2; p < 0.001) and speech (CI -21.8, -5.4, p < 0.001) relative to other sites. Advanced T stage predicted worse anxiety (CI -13.0, -2.0, p = 0.03). CONCLUSIONS Surgical approach, management of cervical disease, tumor extent, and site of involvement impacted variable UWQOL symptom areas. Endoscopic resection predicted better pain, appearance, and chewing compared with open. These results may aid in counseling patients regarding potential QOL expectations in their SNM treatment and recovery course.
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Affiliation(s)
- Sabrina L Maoz
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Autreen Golzar
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Eric W Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Nithin D Adappa
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Christopher H Le
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona, USA
| | - Carlos D Pinheiro-Neto
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jakob L Fischer
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Erik P Chan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Eugene H Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Michael A Kohanski
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jivianne K Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Jillian W Lazor
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali Nabavizadeh
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - James N Palmer
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Adam C Resnick
- Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Carl H Snyderman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maie A St John
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Phillip B Storm
- Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Myung S Sim
- Department of Medicine-Statistics Core, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
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Girod-Roux M, Tuomi L, Finizia C, Beldjoudi A, Métayer C, Faraoni F, Fiot L, Buiret G. A translation and validation of the French version of the Gothenburg Trismus Questionnaire 2 (F-GTQ-2). J Oral Rehabil 2024; 51:1034-1040. [PMID: 38486491 DOI: 10.1111/joor.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 09/29/2023] [Accepted: 02/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Limitation of mouth opening, widely known as trismus, is a major symptom altering quality of life in individuals presenting from temporomandibular joint disorder or head and neck cancer. A French-language instrument addressing jaw opening limitation following treatment for head and neck cancer (HNC) or temporomandibular joint disorder (TMD) is lacking. OBJECTIVE The aim of this study was to translate and validate the Gothenburg Trismus Questionnaire-2 (GTQ-2) into French. METHODS A French translation of the GTQ-2 was performed according to established international guidelines, leading to the French-GTQ-2 (F-GTQ-2). The validation study included 154 participants with trismus (minimum interincisal opening of ≤35 mm) following treatment for TMD or HNC and 149 age-matched participants without trismus. All participants completed the F-GTQ-2 and participants with trismus completed additional health-related quality of life questionnaires to allow for analysis of convergent validity. RESULTS The F-GTQ-2 demonstrated retained psychometric properties with Cronbach's alpha values above 0.70 for the domains, jaw-related problems, eating limitations, facial pain and somewhat lower for muscular tension (0.60). Mainly moderate correlations were found when comparing the F-GTQ-2 to other instruments, which was in line with the pre-specified hypotheses, indicating satisfactory convergent validity. Discriminant validity was found with statistically significant differences in all domains of the F-GTQ-2 between trismus and non-trismus participants. CONCLUSION The F-GTQ-2 can be considered a reliable and valid instrument to assess jaw-related difficulties in individuals with trismus due to HNC or TMD.
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Affiliation(s)
- Marion Girod-Roux
- Hôpital Sud, Centre Hospitalier Universitaire Grenoble Alpes, Échirolles, France
- University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand
| | - Lisa Tuomi
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anaïs Beldjoudi
- Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
- Département Orthophonie, Institut des Sciences et Techniques de Réadaptation, Université Claude Bernard Lyon 1, Lyon, France
| | - Claire Métayer
- Département Orthophonie, Institut des Sciences et Techniques de Réadaptation, Université Claude Bernard Lyon 1, Lyon, France
| | - Floriane Faraoni
- Département Orthophonie, Institut des Sciences et Techniques de Réadaptation, Université Claude Bernard Lyon 1, Lyon, France
| | - Lucile Fiot
- Département Orthophonie, Institut des Sciences et Techniques de Réadaptation, Université Claude Bernard Lyon 1, Lyon, France
| | - Guillaume Buiret
- Centre Hospitalier de Valence, Service d'ORL et de Chirurgie Cervicofaciale, Valence, France
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Zaitoun A, Fata M, Shafei ME, Abdeldayem M, Koraitim M. Application of supraclavicular island flap in oral and maxillofacial reconstruction. Oral Maxillofac Surg 2024; 28:893-908. [PMID: 38355871 DOI: 10.1007/s10006-024-01225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
Several surgical modalities are available for maxillofacial reconstruction as locoregional or microvascular free flaps. PURPOSE (a) Evaluate the reliability of the supraclavicular flap in cervico-orofacial region; (b) investigate the role of computed tomography angiography (CTA) in predicting the post-operative viability of the flap; (c) assess the speech, feeding, and esthetics after reconstruction using this flap. METHODS Eleven patients included in this study underwent either conventional or delayed harvesting of the supraclavicular flap (SCF). All the patients had diagnostic computed tomography angiography (CTA) of the supraclavicular flap before the surgery. RESULTS The mean harvesting time of the flap was 45.45 ± 4.16 min. The average length of the flap was 22.64 ± 1.12 cm, whereas the mean width of the flap was 6.14 ± 1.14 cm. The flap survived in 9 patients, while two patients had complete flap loss. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. Only two patients complained of weakness in the donor site. None of the patients reported that the weakness or pain at the donor site affected their daily activities or quality of life. CONCLUSION The pedicled SCF represents a safe and feasible option that can be used to reconstruct a wide array of maxillofacial oncologic defects. However, a study with a larger sample size is recommended to achieve more reliable clinical results for the modified delayed technique modification in terms of their effect on the survival of the supraclavicular flap.
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Affiliation(s)
- Abdalla Zaitoun
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Mohamed Fata
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed El Shafei
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Abdeldayem
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Koraitim
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Sharma S, Kumar Upadhyay A, Prakash A, Singodia P, Ravi Kiran S, Shankar R. Treatment Complications of Head and Neck Cancers and Rehabilitation Measures: A Narrative Review. Cureus 2024; 16:e61173. [PMID: 38933634 PMCID: PMC11204137 DOI: 10.7759/cureus.61173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Head and neck cancers (HNCs) are malignant tumors mainly from squamous cells in the head and neck tissues. Treatment involves a multidisciplinary approach with surgery, radiotherapy, and chemotherapy. However, the long-term prognosis for patients with advanced-stage tumors is guarded, with a median survival time of approximately 24 months. HNC patients have very high rates of depression and anxiety and the highest suicide rate among all cancers due to the intense and challenging nature of the treatment, underscoring the importance of our collective efforts. Rehabilitation success depends on various factors, including tumor, patient, and treatment-related factors. Patients may require post-treatment oral rehabilitation measures, including implants, obturators, and flexible dentures. These measures are crucial, but they often need to be more utilized. Patients may face challenges in maintaining oral hygiene and managing mucositis. Additionally, it is essential to address other intricacies such as trismus, xerostomia, gustatory dysfunctions, neuropathy, speech impairments, and psychological disturbances. Unfortunately, there is little literature on post-treatment rehabilitative measures. Despite its crucial role in improving patients' quality of life, rehabilitation often receives inadequate attention compared to treatment. Our narrative review, which covers various factors that affect rehabilitation, including oral rehabilitation measures and post-treatment complications, is anticipated to deliver practical insights to professionals and inspire positive changes in their regular practice.
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Affiliation(s)
- Swati Sharma
- Prosthodontics, Crown and Bridge & Oral Implantology, Tata Main Hospital, Jamshedpur, IND
| | | | | | | | - Sarat Ravi Kiran
- Oral and Maxillofacial Surgery, Tata Main Hospital, Jamshedpur, IND
| | - Rama Shankar
- Oral and Maxillofacial Surgery, Tata Main Hospital, Jamshedpur, IND
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Mumaw DA, Nassif TM, Witsil MA, Deraniyagala RL. Boswellia serrata Enhances Passive Range-of-Motion Exercises in Radiation-Induced Trismus: A Case Report. Cureus 2024; 16:e58234. [PMID: 38745799 PMCID: PMC11092424 DOI: 10.7759/cureus.58234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
Trismus is a common, extremely detrimental side effect following definitive radiotherapy for head and neck malignancies. Existing therapeutic modalities (active and passive range-of-motion exercises and systemic therapies) offer only modest, slow improvements in jaw opening; thus, there is a need for additional treatment options. Boswellia serrata (BS) ("Indian frankincense") is a tree native to West Asia and North Africa that produces resin-containing "boswellic" acids. These have been shown to have in vitro and in vivo anti-inflammatory effects and have previously been found to be an effective treatment for asthma, colitis, arthritis, and post-radiation edema. Herein we report the case of a 54-year-old male with severe post-radiation trismus who experienced a dramatic resolution with BS/Therabite® combination therapy. His trismus improved from 6 mm to 45 mm over 10 weeks (0.46 mm/day), far exceeding previous rates of improvement documented in the literature. There were no ill effects. Given the dearth of effective treatments for post-radiation trismus, BS is a promising agent deserving of further study.
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Affiliation(s)
- Derek A Mumaw
- Radiation Oncology, Beaumont Hospital, Royal Oak, USA
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Nayiga BK, Abrams SW, Rhayel A, Edward H, Tang A, Kho ME, Sebestien H, Smith-Turchyn J. Exploring the use of rehabilitation in individuals with head and neck cancer undergoing treatment: a scoping review. Disabil Rehabil 2024:1-21. [PMID: 38494954 DOI: 10.1080/09638288.2024.2328810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
Explore the use, characteristics, feasibility, and functional outcomes of rehabilitation interventions used for individuals with head and neck cancer (HNC) during treatment. Searches were conducted in four databases from Jan 2011 to Dec 31, 2022. Included studies had to include adults with HNC undergoing treatment, a rehabilitation intervention, an assessment of functional outcome(s) addressed by the International Classification of Functioning Framework (ICF) and be published in English language. Title and abstract screening, full-text review, and data extraction were completed independently, in duplicate. Descriptive statistics and a qualitative synthesis summarized findings. Twenty-seven studies were included in this review. The majority of studies were randomized controlled trials (70%). Most individuals represented in the included studies were males (92% of all participants) between 50 and 60 years of age. Interventions led by a speech language pathologist (33%) were most commonly described. Sixteen studies (59%) described primary outcomes that fit the ICF "impairment" domain. We identified few studies that explored the use, feasibility, and effectiveness of rehabilitation interventions for individuals with HNC during treatment. Future research should assess the effectiveness of rehabilitation interventions on functional outcomes beyond the ICF body function and structure domain.
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Affiliation(s)
- Brenda Kibuka Nayiga
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Sophia Werden Abrams
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ashwak Rhayel
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Holly Edward
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Hotte Sebestien
- Department of Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Jenna Smith-Turchyn
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Yang L, Hao G, Hou L, Yang W. Rehabilitation strategies for trismus post oral cancer treatment: Progress in the study of mouth opening exercises. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101796. [PMID: 38331216 DOI: 10.1016/j.jormas.2024.101796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/10/2024]
Abstract
Oral cancer is a significant public health issue worldwide. Although its treatment methods effectively control tumor growth, they can lead to complications, including Trismus, severely affecting patients' quality of life. The practice standards for mouth opening exercises, a rehabilitative method to prevent and treat Trismus, are not yet clear. Therefore, this article aims to review the research progress of mouth opening exercises in the rehabilitation of Trismus post oral cancer treatment, providing a scientific and effective rehabilitation plan for oral cancer patients to improve their quality of life.
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Affiliation(s)
- Ling Yang
- Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China; Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Guihua Hao
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Lili Hou
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Wenyu Yang
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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Hoffmann KJ, Büsch C, Moratin J, Ristow O, Hoffmann J, Mertens C. Peri-implant health after microvascular head and neck reconstruction-A retrospective analysis. Clin Oral Implants Res 2024; 35:187-200. [PMID: 38010660 DOI: 10.1111/clr.14214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/04/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Prosthodontic rehabilitation after reconstruction with microvascular revascularized free flaps following ablative tumor surgery is challenging due to the altered anatomical and functional conditions. The aim of this retrospective study was to determine whether the type of graft and the type of peri-implant tissue have an effect on peri-implant inflammatory parameters and implant survival. MATERIALS AND METHODS Patients who received a free flap reconstruction with subsequent implant-prosthetic rehabilitation between 2010 and 2022 were retrospectively included. The primary outcome variable was the probing depth (PPD) at a minimum of 1 year after completion of prosthetic restoration. Predictive variables were type of free flap, emergence profile, and history of radiation. RESULTS Seventy-one patients after free flap reconstruction were included in the analysis. At a minimum of 24 months after implant insertion the primary outcome, PPD showed no clinically relevant differences between the types of free flaps used. The emergence profile through a skin island resulted in an increase in BOP compared to native mucosa in the descriptive analysis (p-value > .05). The analysis showed a 5-year implant survival of 96.2% (95% CI: 0.929-0.996) in cases without irradiation and 87.6% (95% CI: 0.810-0.948) with irradiation of the region evaluated (p-value .034). CONCLUSION Flap and associated soft tissue type had no significant effect on 5-year implant survival or peri-implant inflammatory parameters. However, the large heterogeneity of the patient population indicates that further prolonged studies are required for a more differentiated assessment of the long-term success.
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Affiliation(s)
- Korbinian Jochen Hoffmann
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher Büsch
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Julius Moratin
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Ristow
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Mertens
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Thaduri A, Kappari SR, Majumdar KS, Panuganti A, Usmani SA, Singh V, Moideen A, Malhotra M, Garg PK. Long-term swallow outcomes and factors affecting swallowing dysfunction and quality of life among oral cancer patients: a prospective observational study. Eur Arch Otorhinolaryngol 2023; 280:5091-5100. [PMID: 37548702 DOI: 10.1007/s00405-023-08155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Oral cancer is one of the most common cancers among the Indian population. India bears the most burden of oral cancer globally. Impairment of swallowing function is often seen after treatment for oral cancer. The oral phase of swallowing is disrupted in patients undergoing resection for oral cancer. The primary purpose of this study was to evaluate the long-term swallowing outcomes of oral cancer patients using a patient-reported outcome questionnaire. METHODOLOGY All consecutive oral cancer patients in the cT2-T4 category undergoing curative-intent surgery and reconstruction at our institute from March 2020 to March 2022 were included in the study. The Sydney Swallow questionnaire (SSQ) and functional oral intake scale (FOIS) assessed swallowing outcomes six months after definitive treatment. WHO BREF quality-of-life questionnaire was used to assess health-related quality of life. RESULTS A total of seventy patients with oral cancer were included. The median age was 49 years. The majority of them were males (90%). Tumors with cT4 constituted 62%; the rest, 48%, were cT2 and cT3 categories. The bulk of them were buccoalveolar tumors (64.3%. Almost two-thirds of the patients received multimodal treatment. Trismus and xerostomia were at 46% and 88%, respectively. The mean SSQ score was 257.4 ± 99.1. Swallowing outcomes are affected by T stage (p = 0.01), extent of resection (p = 0.01), multimodality treatment (p < 0.01), trismus (p = 0.05), and xerostomia (p = 0.01). Almost 69% of them required special food preparation for swallowing (FOIS 4&5). Patients with buccoalveolar disease (p = 0.05) had significantly poor quality of life. CONCLUSION An advanced stage with extensive resection and receiving multimodal treatment has adverse swallowing outcomes. Post-treatment trismus and xerostomia also significantly affected swallowing results.
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Affiliation(s)
- Abhinav Thaduri
- Department of ENT, Prathima Relief Medical College, Warangal, India.
- Head and Neck Services, Prathima Cancer Institute, Warangal, India.
| | - Sravani Reddy Kappari
- Department of ENT, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, India
| | | | - Achyuth Panuganti
- Department of ENT, Mediciti Institute of Medical Sciences, Hyderabad, India
| | | | - Vikramjit Singh
- Department of ENT&Head and Neck Surgery, AIIMS, Rishikesh, India
| | - Areej Moideen
- Department of ENT&Head and Neck Surgery, AIIMS, Rishikesh, India
| | - Manu Malhotra
- Department of ENT&Head and Neck Surgery, AIIMS, Rishikesh, India
| | - Pankaj Kumar Garg
- Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Science, Dehradun, India
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11
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Woodford SC, Robinson DL, Abduo J, Lee PVS, Ackland DC. Kinematics of the jaw following total temporomandibular joint replacement surgery. J Biomech 2023; 159:111741. [PMID: 37660523 DOI: 10.1016/j.jbiomech.2023.111741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023]
Abstract
Total temporomandibular joint (TMJ) replacement surgery aims to improve mandibular function, reduce pain and enhance quality of life in patients suffering from end-stage TMJ disorders. Traditional post-operative jaw evaluation is carried out using measurement of maximum interincisal opening distance; however, this can correlate poorly to joint function. The present study aimed to evaluate three-dimensional (3D) jaw motion during border movements and chewing in unilateral total TMJ replacement patients and healthy controls. Motion analysis experiments were performed on six unilateral total TMJ replacement patients and ten age-matched healthy controls. Subject-specific motion tracking plates worn by each participant were registered to CT scans of each participant's skull and mandible to enable anatomical mandibular kinematics measurement using an optoelectronic system. Participants performed 15 repetitions of maximal opening, protrusion, lateral excursions, and chewing cycles. Total TMJ replacement patients had significantly smaller incisal displacements at maximum mouth opening relative to the controls (median difference: 7.1 mm, p = 0.002) and decreased anterior translation of the prosthetic condyle (median difference: 10.5 mm, p = 0.002). When TMJ replacement subjects chewed using their contralateral molars, there was a significant increase in inferior condylar translation of the non-working condyle (median difference: 9.7 mm, p = 0.016). This study found that unilateral total TMJ replacement surgery was associated with mouth opening capacity within the range of healthy individuals, but reduced anterior movement of the prosthetic condyle and restricted protrusion and lateral excursions. The results provide future direction for prosthetic TMJ design to enhance postsurgical implant functionality and improve long-term clinical outcomes for prosthesis recipients.
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Affiliation(s)
- Sarah C Woodford
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Dale L Robinson
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Jaafar Abduo
- Melbourne Dental School, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Peter V S Lee
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia.
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12
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Murase M, Pradhan N, Sumita YI, Wakabayashi N. Use of digital technology in prosthesis fabrication for an elderly patient with a maxillectomy and severe trismus: A clinical report. J Prosthet Dent 2023:S0022-3913(23)00330-X. [PMID: 37330360 DOI: 10.1016/j.prosdent.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 06/19/2023]
Abstract
This clinical report describes a novel approach based on digital technology to fabricate a maxillofacial prosthesis for a 90-year-old woman with severe trismus who had undergone maxillectomy on the right side. The approach was safe, rapid, and less burdensome on this elderly patient, and the storage and communication of intraoral and maxillofacial prosthesis data without temporal and spatial constraints was helpful. A combination of digital and analog technology provided a maxillofacial prosthesis that improved the quality of life of this elderly patient with head and neck cancer and severe trismus.
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Affiliation(s)
- Mai Murase
- Specially Appointed Assistant Professor, Department of Advanced Prosthodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Nehasha Pradhan
- Doctoral student, Department of Advanced Prosthodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuka I Sumita
- Professor, The Division of General Dentistry, The Nippon Dental University Hospital, Tokyo, Japan and Adjunct Lecturer, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Noriyuki Wakabayashi
- Professor, Department of Advanced Prosthodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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13
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Ohkoshi A, Ishii R, Higashi K, Nakanome A, Ishikawa K, Katori Y. Trismus after partial maxillectomy and radiotherapy: Free flap reconstruction versus prosthetic obturation. Auris Nasus Larynx 2023; 50:260-265. [PMID: 35688667 DOI: 10.1016/j.anl.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Partial maxillectomy and postoperative radiotherapy are both risk factors associated with trismus. This retrospective study aimed to evaluate the incidence and severity of trismus in patients following partial maxillectomy with or without postoperative radiotherapy and to compare free flap reconstruction and prosthetic obturation. METHODS A retrospective review of 40 oral cancer patients who underwent partial maxillectomy with or without postoperative radiotherapy was performed. Maximum interincisal distance recorded at least 6 months after surgery was classified according to a revised subjective-objective management-analytical (SOMA) scale and compared between the free flap reconstruction group (n = 12) and the prosthetic obturation group (n = 28). RESULTS Trismus was observed in 16/40 (40%) patients, and severe trismus was observed in 4/40 (10%) patients. Although no significant difference in trismus grade was observed between the free flap reconstruction and prosthetic obturation groups, both severe trismus and radiation-induced osteonecrosis were only seen in the prosthetic obturation group with postoperative radiotherapy. CONCLUSION Free flap reconstruction was preferable to prosthetic obturation to avoid severe trismus and radiation-induced osteonecrosis in patients who underwent both partial maxillectomy and postoperative radiotherapy.
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Affiliation(s)
- Akira Ohkoshi
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan.
| | - Ryo Ishii
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
| | - Kenjiro Higashi
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
| | - Ayako Nakanome
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
| | - Kenichiro Ishikawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
| | - Yukio Katori
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
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14
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In Regard to Anderson et al. Int J Radiat Oncol Biol Phys 2023; 115:1009-1010. [PMID: 36822774 DOI: 10.1016/j.ijrobp.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/09/2022] [Indexed: 02/24/2023]
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15
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Navarro-Fernández G, Gil-Martínez A, Diaz-Saez MC, Elizagaray-Garcia I, Pili-Mayayo PQ, Ocampo-Vargas JE, Beltran-Alacreu H. Effectiveness of Physical Therapy in Orthognathic Surgery Patients: A Systematic Review of Randomized Controlled Trials. J Funct Morphol Kinesiol 2023; 8:jfmk8010017. [PMID: 36810501 PMCID: PMC9944893 DOI: 10.3390/jfmk8010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Orthognathic surgery (OS) can present many complications that affect patients' rehabilitation. However, there have been no systematic reviews that assessed the effectiveness of physiotherapy interventions in the postsurgical rehabilitation of OS patients. The aim of this systematic review was to analyze the effectiveness of physiotherapy after OS. The inclusion criteria were randomized clinical trials (RCTs) of patients who underwent OS and who received therapeutic interventions that included any physiotherapy modality. Temporomandibular joint disorders were excluded. After the filtering process, five RCTs were selected from the 1152 initially obtained (two had acceptable methodological quality; three had insufficient methodological quality). The results obtained showed that the effects of the physiotherapy interventions studied in this systematic review on the variables of range of motion, pain, edema and masticatory muscle strength were limited. Only laser therapy and LED showed a moderate level of evidence in the postoperative neurosensory rehabilitation of the inferior alveolar nerve compared with a placebo LED intervention.
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Affiliation(s)
- Gonzalo Navarro-Fernández
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Alfonso Gil-Martínez
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Unit of Physiotherapy, Hospital La Paz-Carlos III, Institute for Health Research IdiPAZ, 28046 Madrid, Spain
- Correspondence: ; Tel.: +34-917401980 (ext. 291)
| | - Marta Carlota Diaz-Saez
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
| | - Ignacio Elizagaray-Garcia
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
| | - Paloma Qinling Pili-Mayayo
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
| | - Julian Esteban Ocampo-Vargas
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
| | - Hector Beltran-Alacreu
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physical Therapy and Nursing, Universidad de Castilla-La Mancha, 45004 Toledo, Spain
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16
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Patterns of Postoperative Trismus Following Mandibulectomy and Fibula Free Flap Reconstruction. Cancers (Basel) 2023; 15:cancers15020536. [PMID: 36672485 PMCID: PMC9856367 DOI: 10.3390/cancers15020536] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/18/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
The factors that contribute to postoperative trismus after mandibulectomy and fibula free flap reconstruction (FFFR) are undefined. We retrospectively assessed postoperative trismus (defined as a maximum interincisal opening ≤35 mm) in 106 patients undergoing mandibulectomy with FFFR, employing logistic regression to identify risk factors associated with this sequela. The surgical indication was primary ablation in 64%, salvage for recurrence in 24%, and osteonecrosis in 12%. Forty-five percent of patients had existing preoperative trismus, and 58% of patients received adjuvant radiation/chemoradiation following surgery. The overall rates of postoperative trismus were 76% in the early postoperative period (≤3 months after surgery) and 67% in the late postoperative period (>6 months after surgery). Late postoperative trismus occurred more frequently in patients with ramus-involving vs. ramus-preserving posterior mandibulotomies (82% vs. 46%, p = 0.004). A ramus-involving mandibulotomy was the only variable significantly associated with trismus >6 months postoperatively on multivariable logistic regression (OR, 7.94; 95% CI, 1.85−33.97; p = 0.005). This work demonstrates that trismus is common after mandibulectomy and FFFR, and suggests that posterior mandibulotomies that involve or remove the ramus may predispose to a higher risk of persistent postoperative trismus.
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17
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Faravel K, Jarlier M, Senesse P, Huteau ME, Janiszewski C, Stoebner A, Boisselier P. Trismus Occurrence and Link With Radiotherapy Doses in Head and Neck Cancer Patients Treated With Chemoradiotherapy. Integr Cancer Ther 2023; 22:15347354221147283. [PMID: 36625502 PMCID: PMC9834786 DOI: 10.1177/15347354221147283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Chemoradiotherapy (CRT) for head and neck cancer (HNC) induces side-effects, including trismus, which impairs quality of life by causing difficulty to eat, speak, and maintain good oral hygiene, and by altering social life. Given the wide variation of reported trismus prevalence and as a first mandatory step for the preventive physiotherapy OPEN program (NCT03979924) this study evaluated trismus occurrence and its link with radiation doses. METHODS Study population was non-larynx HNC patients with epidermoid carcinoma treated with CRT, with or without surgery. A physiotherapist measured maximal interincisal distance before, during and after CRT, at 10 weeks and 6 months. The proportion of patients with trismus (with a 95% confidence interval) was estimated. Irradiation doses were analyzed between patients with and without trismus using non-parametric Kruskal-Wallis test. RESULTS We included 45 patients (77.8% male), median age 61 years (range 41-77). The proportion of trismus at baseline was 24.4%, 26.8% at 10 weeks and 37.1% at 6 months. During radiotherapy, it was 27.9% at week 3 and increased to 41.9% at week 6. Trismus occurrence at 10 weeks was higher when the radiation dose to the ipsilateral lateral pterygoid muscle was above the median value, that is, 36.8 grays. CONCLUSION Trismus occurrence differed according to radiation dose and cancer location. These findings highlight the necessity of early preventive physiotherapy programs to reduce trismus occurrence. The second step, of the interventional multicenter OPEN program, is currently evaluating the impact of preventive physiotherapy and patient education on trismus in a sample of 175 patients.
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Affiliation(s)
- Kerstin Faravel
- University of Montpellier, Montpellier,
France,Kerstin Faravel, Department of Supportive
Care, Physiotherapy Unit, Institut du Cancer de Montpellier (ICM), 208 Avenue
des Apothicaires, Montpellier 34298, France.
| | | | - Pierre Senesse
- University of Montpellier, Montpellier,
France,University of Montpellier INSERM, IRCM,
IDESP, UMR 1302, Montpellier, France
| | | | | | - Anne Stoebner
- University of Montpellier, Montpellier,
France,University of Montpellier INSERM, IRCM,
IDESP, UMR 1302, Montpellier, France
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18
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The role of the speech and language therapist in the rehabilitation of speech, swallowing, voice and trismus in people diagnosed with head and neck cancer. Br Dent J 2022; 233:801-805. [DOI: 10.1038/s41415-022-5145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022]
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19
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Yanwei L, Feng H, Xudong W, Zhanyu P. Traditional Chinese medicine formula 01 for nasopharyngeal carcinoma (NPC01) for head & neck cancer and health-related quality of life: a retrospective study. BMC Complement Med Ther 2022; 22:216. [PMID: 35948924 PMCID: PMC9367151 DOI: 10.1186/s12906-022-03699-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The traditional Chinese medicine (TCM) formula 01 for nasopharyngeal carcinoma (NPC01) is used in the management of head and neck cancers (HNCs), but whether NPC01 has an impact on the HR-QOL of patients with HNCs is unknown.
Methods
This was a retrospective study of patients with HNCs who were treated between January 2019 and January 2020 at the Head & Neck Cancer Center of Tianjin Medical University Cancer Institute & Hospital. The patients were grouped according to whether they received NPC01 or not (controls). All patients routinely completed the EORTC QLQ-C30 and QLQ-H&N35 modules before and after 3 months of systemic treatment. Health economics were collected.
Results
The patients who received NPC01 were older than the controls (48.6 ± 11.4 vs. 43.4 ± 8.8 years, P = 0.004). All other characteristics were comparable between the two groups (all P > 0.05). In EORTC QLQ-C30, physical functioning (P = 0.03), fatigue (P = 0.04), pain (P = 0.02), appetite loss (P = 0.02), and constipation (P = 0.01) scores were improved more in the NPC01 group than in controls. In EORTC H&N35, the scores for pain (P = 0.02), swallowing (P = 0.01), and dry mouth (P = 0.02) were better in the NPC01 group than in controls. The NPC01 cost was 38.94 RMB/patient compared with 12.81 RMB/patient for regular follow-up, but considering insurance coverage, the financial burden was not higher.
Conclusions
The results suggest that NPC01 improves HNCs-related symptoms and HR-QOL.
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Massaccesi M, Dinapoli N, Fuga V, Rupe C, Panfili M, Calandrelli R, Settimi S, Olivieri M, Bartoli FB, Mazzarella C, Longo S, Lajolo C, Boldrini L, Gambacorta MA, Valentini V, Miccichè F. A predictive nomogram for trismus after radiotherapy for head and neck cancer. Radiother Oncol 2022; 173:231-239. [PMID: 35662658 DOI: 10.1016/j.radonc.2022.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study is to develop a prediction model for trismus (maximal interincisal distance equal to or less than 35 millimeters) based on a multivariable analysis of dosimetric and clinical factors METHODS: The Maximum inter-incisal opening (MIO) of HNC patients who underwent radiotherapy (RT) +/- concurrent chemotherapy with radical intent was prospectively measured prior to RT (baseline) and 6 months post-RT. The outcome variable is trismus. The potential risk factors (clinical and dosimetric) were first screened by univariate analysis and then by multivariate analysis. At the end of this process, we used the features identified as relevant to fit a logistic regression model and calculate the probability of observed trismus during the 6-month follow-up after radiation treatment. RESULTS One hundred and four consecutive patients were included (mean age 63 years, range 25-87), 68 were males, 36 females. In the univariate analysis, the MIO at baseline, as an independent variable, and several Vdoses of different masticatory structures were found as significant. Additionally, using a bivariate model, a feature selection process was performed. Finally, we considered as best performing model the MIO at baseline and V42 at Masseter Muscle. The area under curve (AUC) of Receiver Operating Characteristic (ROC) curve value of 0,8255 (95% CI 0.74-0.9). The Hosmer and Lemeshow goodness-of-fit test, used to calibrate our model, is non-significant. CONCLUSIONS A prediction nomogram was developed to assess trismus risk in planning process. An external validation of the model is required to apply it for current clinical use.
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Affiliation(s)
- Mariangela Massaccesi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Nicola Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentina Fuga
- Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Largo Agostino Gemelli, Roma, Italy
| | - Cosimo Rupe
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Panfili
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Radiologia e Neuroradiologia, Polo Diagnostica Per Immagini, Radioterapia, Oncologia ed Ematologia, Area Diagnostica Per Immagini, 00168 Rome, Italy
| | - Rosalinda Calandrelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Radiologia e Neuroradiologia, Polo Diagnostica Per Immagini, Radioterapia, Oncologia ed Ematologia, Area Diagnostica Per Immagini, 00168 Rome, Italy
| | - Stefano Settimi
- Division of Otorhinolaryngology, Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Francesco Beghella Bartoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ciro Mazzarella
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvia Longo
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carlo Lajolo
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Boldrini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Francesco Miccichè
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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McMillan H, Barbon CEA, Cardoso R, Sedory A, Buoy S, Porsche C, Savage K, Mayo L, Hutcheson KA. Manual Therapy for Patients With Radiation-Associated Trismus After Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2022; 148:418-425. [PMID: 35297966 PMCID: PMC8931673 DOI: 10.1001/jamaoto.2022.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/17/2022] [Indexed: 02/03/2023]
Abstract
Importance Trismus is highly prevalent in head and neck cancer (HNC) survivorship. Current standards for trismus treatment include various stretch-based exercise protocols as a primary and single treatment modality with limited evidence regarding the role of manual therapy (MT) for this indication. Objective To assess the effect size and associations of response to MT to increase oral opening in the setting of radiation-associated trismus. Design, Setting, and Participants This retrospective case series was conducted at the University of Texas MD Anderson Cancer Center between 2016 and March 2020 (before COVID-19 interruption) and included 49 disease-free survivors of HNC who were referred for treatment of radiation-associated trismus. Intervention Intraoral MT (including or excluding external head and neck) targeting the muscles of mastication. Main Outcomes and Measures Maximum interincisal opening (MIO) before and after the initial MT session compared with serial MT sessions. Covariates were examined to determine the association with response to MT for trismus. Results A total of 49 survivors of HNC (13 women [27%]; 24 [49%] 64 years or younger; 25 [51%] 65 years or older; mean [range] of 6.6 [0-33] years postradiotherapy were included, 9 [18.4%] of whom underwent a single MT session; 40 [81.6%] who underwent multiple sessions [mean, 6; median (range), 3 (2-48)]). The MIO improved after a single session by a mean (SD) of 4.1 (1.9) mm (0.45 effect size) and after serial MT sessions by a mean (SD) of 6.4 (4.8) mm with an effect size of 0.7. No covariates were found to be clinically meaningfully associated with MIO improvement following MT. Conclusions and Relevance The findings of this case series study suggest that MT improved MIO with a medium to large effect size in survivors of HNC with radiation-associated trismus. The results suggest that the largest increase in oral opening was achieved after the initial treatment and although gains were more modest, oral opening continued to improve with serial treatment. Covariates were not associated with MT response, suggesting that patients with clinical features often considered treatment refractory (eg, advanced disease, multiple lines of oncology treatment, ≥5 years posttreatment) may benefit from treatment with MT. Manual therapy may be a beneficial frontline or adjuvant treatment when combined with traditional stretching therapy. A clinically meaningful increase in oral opening has the potential to improve swallow function, speech, pain, and quality of life.
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Affiliation(s)
- Holly McMillan
- M.D. Anderson Cancer Center, Sections of Speech Pathology and Oral Oncology and Maxillofacial Prosthodontics, Department of Head and Neck Surgery, University of Texas, Houston
| | - Carly E. A. Barbon
- M.D. Anderson Cancer Center, Sections of Speech Pathology and Oral Oncology and Maxillofacial Prosthodontics, Department of Head and Neck Surgery, University of Texas, Houston
| | - Richard Cardoso
- M.D. Anderson Cancer Center, Sections of Speech Pathology and Oral Oncology and Maxillofacial Prosthodontics, Department of Head and Neck Surgery, University of Texas, Houston
| | - Abigail Sedory
- Depatment of Biostatistics, University of Texas Health Science Center, Houston
| | - Sheila Buoy
- M.D. Anderson Cancer Center, Sections of Speech Pathology and Oral Oncology and Maxillofacial Prosthodontics, Department of Head and Neck Surgery, University of Texas, Houston
| | - Christine Porsche
- M.D. Anderson Cancer Center, Sections of Speech Pathology and Oral Oncology and Maxillofacial Prosthodontics, Department of Head and Neck Surgery, University of Texas, Houston
| | - Kiara Savage
- M.D. Anderson Cancer Center, Sections of Speech Pathology and Oral Oncology and Maxillofacial Prosthodontics, Department of Head and Neck Surgery, University of Texas, Houston
| | - Lauren Mayo
- Department of Radiation Oncology, M.D. Anderson Cancer Center, Department of Radiation Oncology, University of Texas, Houston
| | - Katherine A. Hutcheson
- M.D. Anderson Cancer Center, Sections of Speech Pathology and Oral Oncology and Maxillofacial Prosthodontics, Department of Head and Neck Surgery, University of Texas, Houston
- Department of Radiation Oncology, M.D. Anderson Cancer Center, Department of Radiation Oncology, University of Texas, Houston
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22
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Wang YH, Huang YA, Chen IH, Hou WH, Kang YN. Exercise for Trismus Prevention in Patients with Head and Neck Cancer: A Network Meta-Analysis of Randomized Controlled Trials. Healthcare (Basel) 2022; 10:442. [PMID: 35326920 PMCID: PMC8951417 DOI: 10.3390/healthcare10030442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022] Open
Abstract
A common side effect of managing head and neck cancer is trismus, which devastates patients' quality of life. The purpose of this study was to investigate prophylactic exercise interventions for preventing trismus and difficulty in mouth opening in head and neck cancer. Five databases were searched for randomized controlled trials. Network meta-analysis was performed with risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). This study finally included 11 randomized controlled trials (n = 805). Trismus risk in patients who received exercise with phone call follow up (E + P) was significantly lower than those received usual care (RR = 0.42; 95% CI: 0.29 to 0.61) and exercise alone (RR = 0.33; 95% CI: 0.18 to 6.22). Mouth opening in usual care was significantly lower than in the tri-integrated strategy group (MD = 15.22; 95% CI: 8.88 to 21.56). Exercise is recommended for preserving mouth opening distance in patients with head and neck cancer. Tri-integrated strategies could be an effective method for preventing trismus.
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Affiliation(s)
- Ya-Hui Wang
- Division of Speech Therapy, Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan; (Y.-H.W.); (Y.-A.H.)
| | - Yi-Ai Huang
- Division of Speech Therapy, Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan; (Y.-H.W.); (Y.-A.H.)
| | - I-Hui Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan;
| | - Wen-Hsuan Hou
- Master Program in Long-Term Care and School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan
- Department of Physical Medicine & Rehabilitation and Geriatrics & Gerontology, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Center of Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei 11031, Taiwan
| | - Yi-No Kang
- Cochrane Taiwan, Taipei Medical University, Taipei 11031, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Xinglong Road, Taipei 11696, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei 100, Taiwan
- Department of Health Care Management, College of Health Technology, National Taipei University of Nursing Health Sciences, Taipei 112, Taiwan
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23
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Vermaire JA, Raaijmakers CPJ, Monninkhof EM, Leeuw IMVD, Terhaard CHJ, Speksnijder CM. Factors associated with masticatory function as measured with the Mixing Ability Test in patients with head and neck cancer before and after treatment: a prospective cohort study. Support Care Cancer 2022; 30:4429-4436. [PMID: 35106658 PMCID: PMC8942951 DOI: 10.1007/s00520-022-06867-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022]
Abstract
Purpose After treatment for head and neck cancer (HNC), patients often experience major problems in masticatory function. The aim of this prospective cohort study among patients with HNC was to investigate which personal and clinical factors are associated with masticatory function from diagnosis up to 2 years after treatment with curative intent. Methods Masticatory function was measured using the Mixing Ability Test (MAT) before treatment (baseline), and 3, 6, 12, and 24 months after treatment. A linear mixed-effects model with a random intercept and slope was conducted to investigate changes over time and the association with personal (sex, age) and clinical (tumor site, tumor stage, treatment modality) factors as measured at baseline. Result One-hundred-twenty-five patients were included. The prevalence of masticatory dysfunction was estimated at 29% at M0, 38% at M3, 28% at M6, 26% at M12, and 36% at M24. A higher (worse) MAT score was associated with age, tumor stage, tumor site, timing of assessment, and the interaction between assessment moment and tumor site. Conclusion In patients with HNC, masticatory function changed over time and dysfunction was associated with a higher age, a tumor in the oral cavity, a higher tumor stage, and a shorter time since treatment. The prevalence of masticatory dysfunction ranged from 26 to 38%. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-06867-0.
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Affiliation(s)
- Jorine A Vermaire
- Department of Radiation Oncology, Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cornelis P J Raaijmakers
- Department of Radiation Oncology, Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Evelyn M Monninkhof
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery and Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Chris H J Terhaard
- Department of Radiation Oncology, Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, G05.122, P.O. Box 85.500, 3508 GA, Utrecht, the Netherlands. .,Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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24
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Hussain T, Tahir H, Rahman OUR, Beg MSA. Cross cheek dumbbell-shaped radial forearm free flap for bilateral trismus release. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2021; 8:140-144. [PMID: 34553006 PMCID: PMC8451691 DOI: 10.1080/23320885.2021.1977137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trismus in post-radiotherapy patients is mostly secondary to fibrosis of buccal mucosa and muscles of mastication. After releasing trismus, mucosal defect needs to be covered with soft and supple tissue. We used a non-conventional method to cover this defect i.e. dumbbell-shape forearm free-flap based on a single radial artery.
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Affiliation(s)
- Touqeer Hussain
- Department of Plastics and Reconstructive Surgery, Liaquat National Hospital, Karachi, Pakistan
| | - Hasan Tahir
- Department of Plastic and Reconstructive Surgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Obaid U R Rahman
- Department of Plastics and Reconstructive Surgery, Liaquat National Hospital, Karachi, Pakistan
| | - Mirza Shehab Afzal Beg
- Department of Plastics and Reconstructive Surgery, Liaquat National Hospital, Karachi, Pakistan
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25
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Bi L, Wei D, Wang B, He JF, Zhu HY, Wang HM. Trismus originating from rare fungal myositis in pterygoid muscles: A case report. World J Clin Cases 2021; 9:6872-6878. [PMID: 34447837 PMCID: PMC8362531 DOI: 10.12998/wjcc.v9.i23.6872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/20/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Trismus is a common problem with various causes. Any abnormal conditions of relevant anatomic structures that disturb the free movement of the jaw might provoke trismus. Trismus has a detrimental effect on the quality of life. The outcome of this abnormality is critically dependent on timely diagnosis and treatment, and it is difficult to identify the true origin in some cases. We present a rare case of trismus due to fungal myositis in the pterygoid muscle, excluding any other possible pathogenesis.
CASE SUMMARY The patient presented with a 2-mo history of restricted mouth opening. Computed tomography showed obvious enlargement of the left pterygoid muscles. Furthermore, the patient had trismus without obvious predisposing causes. The primary diagnosis was pterygoid myosarcoma. Consequently, lesionectomy of the left pterygoid muscle was performed. Intraoperative frozen biopsy implied the possibility of an uncommon infection. Postoperative pathologic examination confirmed myositis and necrosis in the pterygoid muscle. Fungi were detected in both muscle tissue and surrounding necrotic tissue. The patient recovered well with antifungal therapy and mouth opening exercises. The rarity of fungal myositis may be responsible for the misdiagnosis. Although the origin of pathogenic fungi is still unknown, we believe that both hematogenous spread and local invasion could be the most likely sources. To the best of our knowledge, this is the first case in the literature that reported fungal myositis in pterygoid muscles as the only reason that results in trismus.
CONCLUSION Surgeons should remain vigilant to the possibility of trismus originating from fungal myositis.
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Affiliation(s)
- Ling Bi
- Department of Stomatology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Dong Wei
- Department of Stomatology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Bo Wang
- Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jian-Feng He
- Department of Stomatology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Hui-Yong Zhu
- Department of Stomatology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Hui-Ming Wang
- Department of Stomatology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, Zhejiang Province, China
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26
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Abboud WA, Hassin-Baer S, Alon EE, Gluck I, Dobriyan A, Amit U, Yahalom R, Yarom N. Restricted Mouth Opening in Head and Neck Cancer: Etiology, Prevention, and Treatment. JCO Oncol Pract 2021; 16:643-653. [PMID: 33049177 DOI: 10.1200/op.20.00266] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Restricted mouth opening or trismus is often encountered in patients with head and neck cancer. The restriction may be the presenting sign of malignancy, a sequela of tumor site or growth, an adverse effect of oncologic treatment, or a first sign of tumoral recurrence. In general, any insult to the temporomandibular joint, masticatory muscles, or their neural innervation may cause limitation in mouth opening. The etiologies leading to trismus are as follows: myospasm secondary to tumor infiltration; reflectory myospasm; radiation-induced myositis and myofibrosis; temporomandibular joint involvement with tumor; unfavorable postsurgical scarring; muscle and joint atrophy secondary to immobilization; pain; jaw fracture and hardware failure; and infection. Preventive measures should be implemented before, during, and after treatment. These measures include identification of high-risk patients, utilization of dose-sculpting radiation techniques whenever possible, performing reconstruction at the same time of resective surgery whenever feasible, and initiating mobilization exercises as early as possible. When trismus develops, treatments are often challenging and disappointing. These include physical therapy, mouth opening appliances, drug therapy, and release surgery. All medical specialties dealing with head and neck cancer should be familiar with the diagnosis and prevention of trismus and make an effort to ensure patients are referred to the appropriate care when needed. Trismus should not be considered a trivial sequela of head and neck cancer.
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Affiliation(s)
| | | | - Eran E Alon
- Sheba Medical Center at Tel HaShomer, Tel Aviv, Israel
| | - Iris Gluck
- Sheba Medical Center at Tel HaShomer, Tel Aviv, Israel
| | - Alex Dobriyan
- Sheba Medical Center at Tel HaShomer, Tel Aviv, Israel
| | - Uri Amit
- Sheba Medical Center at Tel HaShomer, Tel Aviv, Israel
| | - Ran Yahalom
- Sheba Medical Center at Tel HaShomer, Tel Aviv, Israel
| | - Noam Yarom
- Sheba Medical Center at Tel HaShomer, Tel Aviv, Israel
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27
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Late radiation effects in survivors of head and neck cancer: State of the science. Crit Rev Oncol Hematol 2021; 162:103335. [PMID: 33992801 DOI: 10.1016/j.critrevonc.2021.103335] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 01/15/2023] Open
Abstract
Head and neck squamous cell carcinoma is one of the most common neoplasms. Radiotherapy (RT) plays an essential role in the management of such cases. Despite advances in the technique, hyposalivation, xerostomia, dysphagia, trismus, radiation caries, and osteoradionecrosis remain significant late complications of RT. The aim of this narrative review was to summarize and update the main findings related to late side effects of radiotherapy in survivors of head and neck cancer (HNC). Such effects limit the ability to speak, ingest food and medications, and breathe and also exert a negative impact on social well-being and quality of life. This review highlights research in the field for both researchers and clinicians, assisting in the prevention and management of these adverse conditions. The findings can contribute to improving preventive management and multidisciplinary interventions for HNC patients.
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28
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Moreno Soriano C, Castañeda Vega P, Estrugo Devesa A, Jané Salas E, López López J. Frequency and type of digital procedures used for the intraoral prosthetic rehabilitation of patients with head and neck cancer: A systematic review. J Prosthet Dent 2021; 127:811-815. [PMID: 33431172 DOI: 10.1016/j.prosdent.2020.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
STATEMENT OF PROBLEM In spite of a digital workflow playing an important role in the intraoral prosthetic rehabilitation of patients with head and neck cancer, information about how it has been implemented and its clinical implications is sparse. PURPOSE The purpose of this systematic review was to evaluate the use of a digital workflow in the intraoral prosthetic rehabilitation of patients with head and neck cancer by analyzing the frequency and type of the digital procedures used. MATERIAL AND METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The following terms were applied for the search conducted in the MEDLINE-PubMed, Cochrane, and SciELO databases: (prosthesis OR dental OR rehabilitation) AND (digital OR CAD-CAM OR intraoral scanner) AND (Cancer OR head neck). Articles that specified data on intraoral prosthetic treatment and analyzed the use of a digital workflow in the different prosthetic phases such as digital scanning and computer-aided design and computer-aided manufacturing (CAD-CAM) in patients with head and neck cancer were included. Data from the frequency and type of digital procedures were analyzed. RESULTS Thirteen articles were included, and all had incorporated CAD-CAM techniques in at least 1 of the prosthetic treatment stages (scanning, design, and/or fabrication). Only 1 patient was rehabilitated by using a completely digital workflow. The most frequent prosthetic treatment was an obturator (82.6%). Regarding the image capture method, the most used method was cone beam computed tomography (CBCT) (60.9%). CONCLUSIONS Most reports described the partial use of a digital workflow in the intraoral prosthetic rehabilitation of patients treated for head and neck cancer. A digital workflow is used for specific stages but not for the entire process. More studies are needed to evaluate digital systems, ideally comparing parameters with the conventional method, and to determine whether this technique has more relevant clinical implications.
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Affiliation(s)
- Carlos Moreno Soriano
- Professor of Master in Dentistry for Cancer and Immunocompromised Patients, Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paul Castañeda Vega
- Professor of Master in Dentistry for Cancer and Immunocompromised Patients, Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Estrugo Devesa
- Professor of Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Researcher of Oral Health and Masticatory System Group, Institut d'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Enric Jané Salas
- Professor of Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Researcher of Oral Health and Masticatory System Group, Institut d'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregat, Barcelona, Spain
| | - José López López
- Professor of Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Researcher of Oral Health and Masticatory System Group, Institut d'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregat, Barcelona, Spain; Medical Manager and Head of the Medical-Surgical Area of Dentistry Hospital University of Barcelona, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
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Further validation of the Gothenburg Trismus Questionnaire (GTQ). PLoS One 2020; 15:e0243805. [PMID: 33332402 PMCID: PMC7746186 DOI: 10.1371/journal.pone.0243805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/26/2020] [Indexed: 11/19/2022] Open
Abstract
This study aimed to update and, if necessary, revise the Gothenburg Trismus Questionnaire (GTQ), the only existing trismus-specific questionnaire, and retest its psychometric properties. Semi-structured interviews were performed with 10 trismus patients of which 5 had head and neck cancer (HNC) and 5 suffered from benign temporomandibular disorders. Trismus was defined as a maximal incisal opening of ≤ 35mm. An expert panel discussed and revised the GTQ based on interview information, expertise knowledge and the original questionnaire. The revised questionnaire was then tested in a study sample consisting of benign jaw-related conditions (n = 26), patients treated for HNC (n = 90) and an age- and gender-matched control group with no trismus (n = 116). The revised version of the GTQ (GTQ 2) was well accepted by patients. The original three domains continued to show high internal consistency (Cronbach’s alpha 0.74–0.94) and construct validity. Two dually posed single items were split into four questions and the wording was altered in another three items. Moreover, a new domain (Facial pain) was identified, which had excellent internal consistency (α = 0.96) and good construct validity. The revision of the original Gothenburg Trismus Questionnaire (GTQ 1) with inclusion of patient-input, resulted in splitting of ambiguous items, identifying a fourth domain named Facial pain and the recall time shortened for some items. Additionally, the remaining domains and items were re-confirmed as strong in the psychometric analysis. Henceforth, the new version, GTQ 2 should be used.
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30
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Miranda RRD, Lopes CDCA, Franco NMAS, Cabral LC, Simamoto JÚnior PC, Novais VR. Head and neck cancer therapy-related oral manifestation management in the COVID-19 pandemic: a critical review. Braz Oral Res 2020; 34:e120. [PMID: 33146316 DOI: 10.1590/1807-3107bor-2020.vol34.0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/04/2020] [Indexed: 12/23/2022] Open
Abstract
With the onset of the new coronavirus disease (COVID-19) pandemic, the dental treatment of patients at risk of infection has become quite challenging. In view of this, patients with head and neck cancer may present with oral complications due to anticancer therapy, making dental assistance necessary. Thus, the objective of the study was to review the literature and critically discuss important concerns about the treatment of patients with head and neck cancer during the COVID-19 pandemic. Because dental professionals are in close contact with the main viral transmission routes, this study presents recommendations for management and protection during clinical dental care. The main characteristics and transmission routes of COVID-19 are also discussed. Dental professionals should control pain and the side effects of antineoplastic treatment and use preventive measures for infection control. During this pandemic, patients with head and neck cancer should not undergo elective procedures, even if they do not have symptoms or a history of COVID-19; therefore, in asymptomatic or painless cases, only preventive actions are recommended. In symptomatic or painful cases, precautions for safe interventional treatments must be implemented by following the hygiene measures recommended by health agencies and using personal protective equipment. During health crises, new protocols emerge for cancer treatment, and professionals must act with greater attention toward biosafety and updated knowledge. It is important to offer adequate individualized treatment based on the recommendations of preventative and interventional treatments so that patients can face this difficult period with optimized quality of life.
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Affiliation(s)
- Rafael Resende de Miranda
- Universidade Federal de Uberlândia - UFU, School of Dentistry , Department of Operative Dentistry and Dental Materials , Uberlândia , MG , Brazil
| | - Camila de Carvalho Almança Lopes
- Universidade Federal de Uberlândia - UFU, School of Dentistry , Department of Removable Prosthodontics and Dental Materials , Uberlândia , MG , Brazil
| | | | - Luana Cardoso Cabral
- Faculdade Morgana Potrich - FAMP, School of Dentistry , Department of Oclusion, Fixed Prosthesis and Dental Materials , Mineiros , GO , Brazil
| | - Paulo Cézar Simamoto JÚnior
- Universidade Federal de Uberlândia - UFU, School of Dentistry , Department of Oclusion, Fixed Prosthesis and Dental Materials , Uberlândia , MG , Brazil
| | - Veridiana Resende Novais
- Universidade Federal de Uberlândia - UFU, School of Dentistry , Department of Operative Dentistry and Dental Materials , Uberlândia , MG , Brazil
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Montalvo C, Finizia C, Pauli N, Fagerberg-Mohlin B, Andréll P. Impact of exercise with TheraBite device on trismus and health-related quality of life: A prospective study. EAR, NOSE & THROAT JOURNAL 2020:145561320961727. [PMID: 33035128 DOI: 10.1177/0145561320961727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Trismus is a common symptom in patients with head and neck cancer that affects many aspects of daily life negatively. The aim of this study was to investigate the impact of structured exercise with the jaw-mobilizing device TheraBite on trismus, trismus-related symptomatology, and health-related quality of life (HRQL) in patients with head and neck cancer. Fifteen patients with trismus (maximum interincisal opening [MIO] ≤35 mm) after oncologic treatment for head and neck cancer, underwent a 10-week exercise program with the TheraBite device and were followed regularly. Time between oncologic treatment and start of TheraBite exercise ranged from 0.7 to 14.8 years (average 6.2 years). MIO, trismus-related symptoms, and HRQL was assessed before and after exercise and after 6 months. A significant improvement in MIO was observed post-exercise (3.5 mm, 15.3%, p = 0.0002) and after 6-month of follow-up (4.7 mm, 22.1%, p = 0.0029). A statistically significant correlation was found between increased MIO and fewer trismus-related symptoms. In conclusion, exercise with TheraBite improved MIO and trismus-related symptoms in patients with trismus secondary to head and neck cancer. Structured exercise with the jaw-mobilizing device seems to be beneficial for patients with trismus independent of time since oncologic treatment.
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Affiliation(s)
- Charlotte Montalvo
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Nina Pauli
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Bodil Fagerberg-Mohlin
- Department of Oral and Maxillofacial Surgery, Faculty of Odontology, Sahlgrenska University Hospital, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Paulin Andréll
- Department of Molecular and Clinical Medicine/Multidisciplinary Pain Centre, Sahlgrenska University Hospital, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
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Martins CA, Goldenberg DC, Narikawa R, Kowalski LP. Trismus and oral health conditions during diagnosis of malignant oral neoplasms. Braz J Otorhinolaryngol 2020; 86:552-557. [PMID: 30962143 PMCID: PMC9422627 DOI: 10.1016/j.bjorl.2019.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/12/2018] [Accepted: 02/11/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Trismus has been considered a late complication of cancer treatment. It can occur prior to treatment, mainly caused by tumor invasion or muscle spasms induced by the presence of the tumor. OBJECTIVE In this study, we evaluated the incidence of trismus and its effect on oral health in patients with malignant neoplasms of the oral cavity before performing the cancer treatment. METHODS This review was carried out via interviews, visual clinical inspection and objective measurement of maximal mouth opening in 35 consecutive patients. Trismus was defined as a maximal mouth opening <35mm. RESULTS Trismus was observed in 15 patients, with a total incidence of 42%. A high rate of tooth loss was recorded, and trismus association with tooth loss was statistically verified using the Chi-square and Fisher's exact tests, the t-student test and Mann-Whitney non-parametric test. All tests were performed at p<0.05. CONCLUSION Edentulous patients are eight times more likely to have trismus compared to patients that are partially and fully dentate. Trismus was demonstrated to be correlated with tooth loss; however other oral health conditions were not shown to be a modifying factor.
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Cardoso RC, Kamal M, Zaveri J, Chambers MS, Gunn GB, Fuller CD, Lai SY, Mott FE, McMillan H, Hutcheson KA. Self-Reported Trismus: prevalence, severity and impact on quality of life in oropharyngeal cancer survivorship: a cross-sectional survey report from a comprehensive cancer center. Support Care Cancer 2020; 29:1825-1835. [PMID: 32779007 DOI: 10.1007/s00520-020-05630-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to estimate prevalence/severity of self-reported trismus, determine association with quality of life (QOL), and examine clinical risk factors in a large population of patients treated for oropharyngeal cancer. MATERIALS AND METHODS A cross-sectional survivorship survey was conducted among patients who completed definitive treatment for oropharyngeal carcinoma, disease-free ≥ 1-year post-treatment (median survival, 7 years among 892 survivors). Associations between trismus and QOL were also analyzed using MDASI-HN, EQ-5D, and MDADI. Dietary and feeding tube status were also correlated to trismus status. RESULTS Trismus was self-reported in 31%. Severity of trismus positively correlated (r = 0.29) with higher mean interference scores reflecting a moderate association with quality of life (p < 0.0001). There was a negative correlation for MDADI composite scores (r = - 0.33) indicating increased perceived dysphagia related to trismus severity (p < 0.0001). EQ-5D VAS scores were also negatively correlated with trismus severity (r = - 0.26, p < 0.0001). Larger T-stage (p ≤ 0.001), larger nodal stage (p = 0.03), tumor sub-site (p = 0.05), and concurrent chemoradiation (p = 0.01) associated with increased prevalence of trismus. Diet negatively correlated (r = - 0.27) with trismus severity (p = < 0.0001), and survivors with severe trismus were also more likely to be feeding tube-dependent. CONCLUSION Severity of trismus appears to negatively impact quality of life and associate with various adverse functional outcomes in long-term oropharyngeal cancer survivorship. Trismus remains associated with advanced disease stages, tumor sub-site (tonsil), and addition of chemotherapy. Further investigation is merited for the dose-effect relationship to the muscles of mastication.
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Affiliation(s)
- Richard C Cardoso
- Departments of Head and Neck Surgery, Medical Oncology, and Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Mona Kamal
- Departments of Head and Neck Surgery, Medical Oncology, and Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jhankruti Zaveri
- Departments of Head and Neck Surgery, Medical Oncology, and Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Mark S Chambers
- Departments of Head and Neck Surgery, Medical Oncology, and Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - G Brandon Gunn
- Departments of Head and Neck Surgery, Medical Oncology, and Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Departments of Head and Neck Surgery, Medical Oncology, and Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Stephen Y Lai
- Departments of Head and Neck Surgery, Medical Oncology, and Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Frank E Mott
- Departments of Head and Neck Surgery, Medical Oncology, and Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Holly McMillan
- Departments of Head and Neck Surgery, Medical Oncology, and Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Katherine A Hutcheson
- Departments of Head and Neck Surgery, Medical Oncology, and Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA.
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Chen W, Li Y, Dyer BA, Feng X, Rao S, Benedict SH, Chen Q, Rong Y. Deep learning vs. atlas-based models for fast auto-segmentation of the masticatory muscles on head and neck CT images. Radiat Oncol 2020; 15:176. [PMID: 32690103 PMCID: PMC7372849 DOI: 10.1186/s13014-020-01617-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/13/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Impaired function of masticatory muscles will lead to trismus. Routine delineation of these muscles during planning may improve dose tracking and facilitate dose reduction resulting in decreased radiation-related trismus. This study aimed to compare a deep learning model with a commercial atlas-based model for fast auto-segmentation of the masticatory muscles on head and neck computed tomography (CT) images. MATERIAL AND METHODS Paired masseter (M), temporalis (T), medial and lateral pterygoid (MP, LP) muscles were manually segmented on 56 CT images. CT images were randomly divided into training (n = 27) and validation (n = 29) cohorts. Two methods were used for automatic delineation of masticatory muscles (MMs): Deep learning auto-segmentation (DLAS) and atlas-based auto-segmentation (ABAS). The automatic algorithms were evaluated using Dice similarity coefficient (DSC), recall, precision, Hausdorff distance (HD), HD95, and mean surface distance (MSD). A consolidated score was calculated by normalizing the metrics against interobserver variability and averaging over all patients. Differences in dose (∆Dose) to MMs for DLAS and ABAS segmentations were assessed. A paired t-test was used to compare the geometric and dosimetric difference between DLAS and ABAS methods. RESULTS DLAS outperformed ABAS in delineating all MMs (p < 0.05). The DLAS mean DSC for M, T, MP, and LP ranged from 0.83 ± 0.03 to 0.89 ± 0.02, the ABAS mean DSC ranged from 0.79 ± 0.05 to 0.85 ± 0.04. The mean value for recall, HD, HD95, MSD also improved with DLAS for auto-segmentation. Interobserver variation revealed the highest variability in DSC and MSD for both T and MP, and the highest scores were achieved for T by both automatic algorithms. With few exceptions, the mean ∆D98%, ∆D95%, ∆D50%, and ∆D2% for all structures were below 10% for DLAS and ABAS and had no detectable statistical difference (P > 0.05). DLAS based contours had dose endpoints more closely matched with that of the manually segmented when compared with ABAS. CONCLUSIONS DLAS auto-segmentation of masticatory muscles for the head and neck radiotherapy had improved segmentation accuracy compared with ABAS with no qualitative difference in dosimetric endpoints compared to manually segmented contours.
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Affiliation(s)
- Wen Chen
- Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, China.,Department of Radiation Oncology, University of California Davis Medical Center, 4501 X Street, Suite 0152, Sacramento, California, 95817, USA
| | - Yimin Li
- Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Brandon A Dyer
- Department of Radiation Oncology, University of California Davis Medical Center, 4501 X Street, Suite 0152, Sacramento, California, 95817, USA.,Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Xue Feng
- Carina Medical LLC, 145 Graham Ave, A168, Lexington, KY, 40536, USA
| | - Shyam Rao
- Department of Radiation Oncology, University of California Davis Medical Center, 4501 X Street, Suite 0152, Sacramento, California, 95817, USA
| | - Stanley H Benedict
- Department of Radiation Oncology, University of California Davis Medical Center, 4501 X Street, Suite 0152, Sacramento, California, 95817, USA
| | - Quan Chen
- Carina Medical LLC, 145 Graham Ave, A168, Lexington, KY, 40536, USA. .,Department of Radiation Oncology, Markey Cancer Center, University of Kentucky, RM CC063, 800 Rose St, Lexington, KY, 40536, USA.
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis Medical Center, 4501 X Street, Suite 0152, Sacramento, California, 95817, USA.
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van der Geer SJ, van Rijn PV, Roodenburg JLN, Dijkstra PU. Prognostic factors associated with a restricted mouth opening (trismus) in patients with head and neck cancer: Systematic review. Head Neck 2020; 42:2696-2721. [PMID: 32558025 PMCID: PMC7496412 DOI: 10.1002/hed.26327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/24/2020] [Accepted: 05/27/2020] [Indexed: 01/05/2023] Open
Abstract
Background To prescribe early trismus therapy, prognostic factors influencing the restricted mouth opening should be identified first. Our aim is to present an overview of these factors in patients with head and neck cancer. Methods PubMed, Cochrane, EMBASE, and CINAHL were searched using terms related to head and neck cancer and mouth opening. Risk of bias was assessed using the “Quality in Prognosis Studies” tool. A best evidence synthesis was performed. Results Of the identified 1418 studies, 53 were included. Three studies contained a prognostic multivariate model for a restricted mouth opening. Conclusions Patients with head and neck cancer will most likely develop a restricted mouth opening when they have a large tumor near the masticatory muscles that requires extensive cancer treatment. A restricted mouth opening most likely occurs within 6 months after cancer treatment. Further research is necessary on factors related to healing tendency or pain intensity.
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Affiliation(s)
- Sarah J van der Geer
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Phillip V van Rijn
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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36
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Bhandari S, Soni BW, Bahl A, Ghoshal S. Radiotherapy‐induced oral morbidities in head and neck cancer patients. SPECIAL CARE IN DENTISTRY 2020; 40:238-250. [DOI: 10.1111/scd.12469] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Sudhir Bhandari
- Unit of ProsthodonticsOral Health Sciences CentrePost Graduate Institute of Medical Education and Research Chandigarh India
| | - Bhavita Wadhwa Soni
- Unit of ProsthodonticsOral Health Sciences CentrePost Graduate Institute of Medical Education and Research Chandigarh India
| | - Amit Bahl
- Department of RadiotherapyPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Sushmita Ghoshal
- Department of RadiotherapyPostgraduate Institute of Medical Education and Research Chandigarh India
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37
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Raj R, Thankappan K, Janakiram C, Iyer S, Mathew A. Etiopathogenesis of Trismus in Patients With Head and Neck Cancer: An Exploratory Literature Review. Craniomaxillofac Trauma Reconstr 2020; 13:219-225. [PMID: 33456691 DOI: 10.1177/1943387520917518] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Trismus refers to a person's inability to normally open his or her mouth. Trismus can occur as a symptom due to tumor ingrowth or it can occur postsurgical following the treatment for head and neck cancer. Radiation-induced trismus is also a relatively common oral complication. This review aimed at reviewing the etiopathogenesis of trismus in patients with head and neck cancer. Of the 16 publications included after final screening, of which one was a nonrandomized control trial, one a randomized control trial, 6 prospective cohort studies, and 8 retrospective cohort studies. Among them, 6 articles addressed the possible mechanism for trismus related to tumor ingrowth, 8 articles suggested the likely reason for trismus in patients who had undergone radiation therapy and 2 articles addressed the postsurgical cause for trismus. This review highlights the possible involvement of infratemporal fossa as a predetermining factor for developing trismus related to tumor extension. The molecular mechanism of radiation-induced fibrosis is well studied in the literature.
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Affiliation(s)
- Radhu Raj
- Department of Prosthodontics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Chandrasekhar Janakiram
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Subramania Iyer
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Anil Mathew
- Department of Prosthodontics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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38
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Kline-Quiroz C, Nori P, Stubblefield MD. Cancer Rehabilitation: Acute and Chronic Issues, Nerve Injury, Radiation Sequelae, Surgical and Chemo-Related, Part 1. Med Clin North Am 2020; 104:239-250. [PMID: 32035566 DOI: 10.1016/j.mcna.2019.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Individuals with cancer commonly experience functional impairments. Symptoms may present immediately or years to decades following their treatment. These impairments may include fatigue, pain, neuropathy, lymphedema, or radiation fibrosis syndrome and have the potential to deleteriously impact their function and quality of life. Cancer rehabilitation is a comprehensive resource that facilitates maximizing and maintaining cancer survivors' physical, social, psychological, and vocational functioning. This article covers the common functional impairments experienced by cancer survivors and the treatment strategies used in cancer rehabilitation. Application of these services can enhance the ongoing care for cancer survivors.
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Affiliation(s)
- Cristina Kline-Quiroz
- MedStar Health/Georgetown, National Rehabilitation Hospital, 102 Irving Street Northwest, Washington, DC 20010, USA
| | - Phalgun Nori
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
| | - Michael D Stubblefield
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Select Medical, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
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39
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Bonzanini LIL, Soldera EB, Ortigara GB, Schulz RE, Knorst JK, Ardenghi TM, Ferrazzo KL. Effect of the sense of coherence and associated factors in the quality of life of head and neck cancer patients. Braz Oral Res 2020; 34:e009. [PMID: 32049110 DOI: 10.1590/1807-3107bor-2020.vol34.0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/10/2019] [Indexed: 11/22/2022] Open
Abstract
The sense of coherence (SOC) is a measure of global orientation regarding the ability of individuals to cope with stressful situations. The aim of the present study was to evaluate the association between SOC and quality of life (QoL) and clinical and sociodemographic characteristics among survivors of oral, oropharynx, hypopharynx, or larynx cancer. A cross-sectional study was conducted with 90 cancer patients in follow up at the Santa Maria University Hospital in southern Brazil who had completed conformal 3D radiotherapy at least three months earlier. QoL was assessed using the University of Washington Quality of Life (UW-QOL) questionnaire and SOC was measured using the Brazilian version of the SOC-13 questionnaire. Data on socio-demographic characteristics and the disease were obtained from patients' charts. Oral clinical conditions were also evaluated. Associations between exploratory variables and mean UW-QOL scores were evaluated through Poisson regression and the results were presented as rate ratios (RR) and 95% confidence intervals (CI). The mean overall UW-QOL score was 67.90 (± 18.71). Moderate and high SOC scores were associated with higher mean UW-QOL scores, that is, individuals with a stronger SOC demonstrated better QoL, (p < 0.05). Regarding the clinical variables, individuals with advanced stage cancer and those with hyposalivation and trismus had poorer QoL (p < 0.05). Patients with a greater SOC reported a better quality of life. Our findings show the importance of focusing on psychosocial factors, which can alleviate the impact caused by the disease and improve the QoL of these patients.
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Affiliation(s)
- Laura Izabel Lampert Bonzanini
- Universidade Federal do Rio Grande do Sul (UFRGS), School of Dentistry, Department of Surgery and Orthopedics, Porto Alegre, RS, Brazil
| | - Eloisa Barbieri Soldera
- Universidade Federal de Santa Maria (UFSM), School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Gabriela Barbieri Ortigara
- Universidade Federal de Santa Maria (UFSM), School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Riéli Elis Schulz
- Universidade Federal de Santa Maria (UFSM), School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Jessica Klöckner Knorst
- Universidade Federal de Santa Maria (UFSM), School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Thiago Machado Ardenghi
- Universidade Federal de Santa Maria (UFSM), School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Kívia Linhares Ferrazzo
- Universidade Federal de Santa Maria (UFSM), School of Dentistry, Department of Pathology, Santa Maria, RS, Brazil
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40
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Moosa Z, Slihem A, Junaidallah A, Alshathri A, Abo Al Samh A, Kandil M. Maximum mouth opening and its association with gender, age, height, weight, body mass index, and systemic disease in adult Saudi population: A cross-sectional study. J Int Oral Health 2020. [DOI: 10.4103/jioh.jioh_254_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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41
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Gangavelli R, Prabhu A, Sundaresan P, Sameera QA. Reliability of a novel method for measuring maximal voluntary mouth opening in patients with oral carcinoma. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2017.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Mouth opening is a routine and vital activity of daily life that facilitates ingestion and speech. It is often found to be limited in patients with oral carcinoma. Measuring mouth opening is essential to detect the therapeutic effect of an intervention aiming to improve it. During measurement, the procedure needs to be reliable, simple, inexpensive and safe. This study aimed to determine the intrarater and interrater reliability of a novel method of measuring maximal voluntary mouth opening in patients with oral carcinoma. Methods Patients aged between 40 and 60 years of either gender with a diagnosis of oral carcinoma and presenting with difficulty in mouth opening were recruited. The distance between incisors was marked on standard sized paper slips as the participants performed maximal voluntary mouth opening. Distance between the markings was measured with a ruler in millimeters. The measurement procedures were carried out by two independent investigators. Results A total of 15 patients (12 male and 3 female) with a mean age of 52.53 ± 8.28 years participated in the study. Mean maximal voluntary mouth opening measure was <35 mm, indicating restricted mouth opening in these patients. Intrarater reliability of 0.95 (0.87–0.98) and interrater reliability of 0.96 (0.89–0.98) were found for the measurements. Conclusions The reliability of maximal voluntary mouth opening measurement using this novel technique was found to be excellent. This technique can be used in the routine clinical evaluation of patients with oral carcinoma.
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Affiliation(s)
- Ranganath Gangavelli
- Associate Professor, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Anupama Prabhu
- Assistant Professor, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Priyadarshini Sundaresan
- Graduate Student, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Quratul Ain Sameera
- Graduate Student, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
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42
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Sandler ML, Lazarus CL, Ru M, Sharif KF, Yue LE, Griffin MJ, Likhterov I, Chai RL, Buchbinder D, Urken ML, Ganz C. Effects of jaw exercise intervention timing on outcomes following oral and oropharyngeal cancer surgery: Pilot study. Head Neck 2019; 41:3806-3817. [PMID: 31407421 DOI: 10.1002/hed.25908] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/17/2019] [Accepted: 07/30/2019] [Indexed: 11/12/2022] Open
Abstract
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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Affiliation(s)
- Mykayla L Sandler
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Cathy L Lazarus
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York.,Department of Otolaryngology Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Department of Otolaryngology Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Meng Ru
- Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kayvon F Sharif
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Lauren E Yue
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Martha J Griffin
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Ilya Likhterov
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York.,Department of Otolaryngology Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Department of Otolaryngology Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raymond L Chai
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York.,Department of Otolaryngology Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Department of Otolaryngology Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel Buchbinder
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York.,Department of Otolaryngology Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Department of Otolaryngology Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark L Urken
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York.,Department of Otolaryngology Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Department of Otolaryngology Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cindy Ganz
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York.,Department of Otolaryngology Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York
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43
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Clinical and sociodemographic factors that affect the quality of life of survivors of head and neck cancer. Support Care Cancer 2019; 28:1941-1950. [DOI: 10.1007/s00520-019-05008-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/24/2019] [Indexed: 12/22/2022]
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44
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Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, Kim MS, Kim JK, Kim H, Nam I, Roh JL, Park YM, Park IS, Park JJ, Shin SC, Ahn SH, Won S, Ryu CH, Yoon TM, Lee G, Lee DY, Lee MC, Lee JK, Lee JC, Lim JY, Chang JW, Jang JY, Chung MK, Jung YS, Cho JG, Choi YS, Choi JS, Lee GH, Chung PS. Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2019; 12:107-144. [PMID: 30703871 PMCID: PMC6453784 DOI: 10.21053/ceo.2018.01816] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient’s treatment goals.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Bon Seok Koo
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology Head and Neck Surgery, CHA University School of Medicine, Seongnam, Korea
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Innchul Nam
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jung Je Park
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seongjun Won
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Tae Mi Yoon
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Giljoon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Chul Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Joon Kyoo Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeon Yeob Jang
- Department of Otorhinolaryngology Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yuh-Seok Jung
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeong-Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Inha University School of Medicine, Incheon, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Phil-Sang Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
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van der Geer SJ, van Rijn PV, Kamstra JI, Langendijk JA, van der Laan BFAM, Roodenburg JLN, Dijkstra PU. Prevalence and prediction of trismus in patients with head and neck cancer: A cross-sectional study. Head Neck 2018; 41:64-71. [PMID: 30561067 PMCID: PMC6590501 DOI: 10.1002/hed.25369] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/06/2018] [Accepted: 05/18/2018] [Indexed: 12/16/2022] Open
Abstract
Background Trismus occurs frequently in patients with head and neck cancer. Determining the prevalence and associated factors of trismus would enable prediction of the risk of trismus for future patients. Methods Based on maximal mouth opening measurements, we determined the prevalence of trismus in 730 patients with head and neck cancer. Associated factors for trismus were analyzed using univariate analyses and multivariate logistic regression analyses. Based on the regression model, a calculation tool to predict trismus was made. Results Prevalence of trismus was 23.6%. Factors associated with trismus were: advanced age; partial or full dentition; tumors located at the maxilla; mandible; cheek; major salivary glands; oropharynx; an unknown primary; a free soft tissue transfer after surgery; reirradiation; and chemotherapy. Conclusion About one‐fourth of patients with head and neck cancer develop trismus. Based on prevalence and associated factors of trismus, a simple calculation tool predicts the risk of trismus in these patients.
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Affiliation(s)
- Sarah J van der Geer
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Phillip V van Rijn
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jolanda I Kamstra
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Pantvaidya G, Sivasanker M, Ranganathan P, Pai P, D'Cruz A. Prospective cross-sectional study assessing prevalence and factors affecting trismus after multimodal treatment for oral cancers. Head Neck 2018; 41:286-290. [PMID: 30548505 DOI: 10.1002/hed.25464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 05/29/2018] [Accepted: 08/15/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Trismus is a common complication following treatment for oral cancers. However, its incidence in site-specific cancers is not adequately studied. The purpose of this study was to assess the prevalence and risk factors associated with trismus in treated patients with oral cancer. METHODS The maximal mouth opening in treated oral cancers was measured. Logistic regression analysis was performed to find risk factors for developing trismus in the entire cohort and in a subgroup of patients with gingivobuccal complex cancers. RESULTS A total of 401 patients were enrolled. The prevalence of trismus was 72.8%. On multivariate analysis, adjuvant therapy and submucous fibrosis were independent predictors. Reconstruction and method of reconstruction did not affect trismus. Bialveolar resections had significantly higher incidence of trismus. DISCUSSION High prevalence of trismus was seen in patients following multimodal therapy for oral cancers. Adequate reconstruction alone may not prevent trismus and aggressive rehabilitation is key to its prevention.
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Affiliation(s)
- Gouri Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | | | - Priya Ranganathan
- Department of Anesthesia and Critical Care, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anil D'Cruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
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van der Geer SJ, van Rijn PV, Kamstra JI, Roodenburg JLN, Dijkstra PU. Criterion for trismus in head and neck cancer patients: a verification study. Support Care Cancer 2018; 27:1129-1137. [PMID: 30109487 PMCID: PMC6373229 DOI: 10.1007/s00520-018-4402-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 08/03/2018] [Indexed: 11/30/2022]
Abstract
Purpose Several cut-off points for trismus in head and neck cancer patients have been used. A mouth opening of 35 mm or less is most frequently used as cut-off point. Due to the variation in cut-off points, prevalence, risk factors and treatment outcomes of trismus cannot be studied in a uniform manner. To provide uniformity, we aimed to verify the cut-off point of 35 mm or less. Additionally, we aimed to determine associated covariates with reported difficulties when opening the mouth. Methods In a cross-sectional design, we measured the mouth opening in 671 head and neck cancer patients at the Department of Oral and Maxillofacial Surgery, at the University Medical Center Groningen. The cut-off point was determined using the receiver operating characteristic curve and Youden index, with reported difficulties when opening the mouth as criterion for trismus. Cut-off points for significant covariates were also determined. Results The Youden index was highest at 35 mm, with a sensitivity of 0.71 and a specificity of 0.86. Of the covariates analysed, type of treatment modality was significantly associated with reported difficulties when opening the mouth. The highest Youden index for patients treated with surgery alone was 37 mm and for patients treated with radiotherapy alone 33 mm. Conclusions The cut-off point of 35 mm or less for trismus was confirmed in a head and neck cancer population and is recommended to be used in future studies. Patients receiving different treatment modalities experience difficulty when opening the mouth differently.
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Affiliation(s)
- Sarah J van der Geer
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Phillip V van Rijn
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Jolanda I Kamstra
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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48
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Zatarain LA, Smith DK, Deng J, Gilbert J, Dietrich MS, Niermann KJ, Ridner SH, Murphy BA. A Randomized Feasibility Trial to Evaluate Use of the Jaw Dynasplint to Prevent Trismus in Patients With Head and Neck Cancer Receiving Primary or Adjuvant Radiation-Based Therapy. Integr Cancer Ther 2018; 17:960-967. [PMID: 29952235 PMCID: PMC6142105 DOI: 10.1177/1534735418784363] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: This study was designed to assess the feasibility of using the Jaw Dynasplint System as an adjunct to conventional stretching exercises as a preventative measure against trismus in patients undergoing radiotherapy. Methods: Study participants (n = 40) were randomized using a permuted block design to conventional stretching or stretching plus use of the Jaw Dynasplint 3 times per day for 30 minutes. Patients were instructed to record maximum interincisal opening each day as well as logging use of the Jaw Dynasplint. Results: At 6 months after initiation of the preventative regimen, 50% of patients in the Dynasplint arm and 75% in the conventional stretching arm remained on their assigned therapy. Trismus was diagnosed in 2 patients in the control arm and in 4 patients in the Dynasplint arm. Only 25% (95% confidence interval = 11.1, 46.9) of patients in the Dynasplint arm used the device as prescribed. Conclusions: The addition of the Jaw Dynasplint decreased compliance compared with conventional stretching. It is unlikely that the prescribed regimen will prove efficacious as a preventative measure due to low compliance.
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Affiliation(s)
| | - Derek K Smith
- 2 Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jie Deng
- 3 University of Pennsylvania, Philadelphia, PA, USA
| | - Jill Gilbert
- 2 Vanderbilt University Medical Center, Nashville, TN, USA
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Lee R, Molassiotis A, Rogers SN, Edwards RT, Ryder D, Slevin N. Protocol for the trismus trial-therabite versus wooden spatula in the amelioration of trismus in patients with head and neck cancer: randomised pilot study. BMJ Open 2018; 8:e021938. [PMID: 29602860 PMCID: PMC5884369 DOI: 10.1136/bmjopen-2018-021938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patients can develop trismus from their head and neck cancer or as a result of treatment. Trismus affects the jaw muscles and makes mouth opening difficult. To potentially combat trismus, patients could undertake proactive jaw stretching exercises prior to, during and after radiotherapy, although currently these are not the standard of care. METHODS AND ANALYSIS This is a randomised, open-label, controlled, two-centre feasibility study, to assess the objective and subjective effectiveness and cost-effectiveness of therabite use compared with wooden spatula in ameliorating trismus in patients treated for stage 3 and 4 oral and oropharyngeal cancer, managed either by primary surgery followed by (chemo)radiotherapy or primary (chemo)radiotherapy. The principal objective assessment is measurement of maximum jaw opening. Assessments in all cases will be performed preradiotherapy and again at 3 and 6 months postintervention.Secondary aims of the study will be (1) to assess whether therabite or the wooden spatula intervention improves patients' quality of life, (2) reduce the level of post-treatment clinical management/healthcare use and (3) a nested qualitative study will explore the experience of the patient taking part in the intervention; data will be transcribed verbatim and analysis will be based on content analysis methods using the interview questions as the framework for examination. ETHICS AND DISSEMINATION North West Greater Manchester granted ethical approval (REC Reference 11/NW/0744). Good Clinical Practice and the Declaration of Helsinki have been adhered to. The results will be presented internationally and submitted to a peer-reviewed journal. Head and neck cancer charities and information websites will also be approached. TRIAL REGISTRATION NUMBER NCT01733797.
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Affiliation(s)
- Rana Lee
- Department of Clinical Oncology, The Christie NHS Foundation Trust Hospital, Manchester, UK
| | - Alex Molassiotis
- The School of Nursing, Hong Kong Polytechnic University, China, Hong Kong
| | - Simon N Rogers
- Evidence-Based Practice Research Centre (EPRC), Edge Hill University, Liverpool, UK
| | | | - David Ryder
- Clinical Trials Unit, The Christie NHS Foundation Trust Hospital, Manchester, UK
| | - Nick Slevin
- Department of Clinical Oncology, The Christie NHS Foundation Trust Hospital, Manchester, UK
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Randomised feasibility study to compare the use of Therabite ® with wooden spatulas to relieve and prevent trismus in patients with cancer of the head and neck. Br J Oral Maxillofac Surg 2018. [PMID: 29526341 PMCID: PMC5948182 DOI: 10.1016/j.bjoms.2018.02.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Our aim was to compare the efficacy of the Therabite® jaw motion rehabilitation system (Atos Medical) with that of wooden spatulas to relieve and prevent trismus in patients who have had radiotherapy for stage three and four oral and oropharyngeal cancer. Secondary aims were to assess the feasibility and the impact of exercise on health-related quality of life (QoL), and the use of health services after treatment. We designed a randomised, open-label, controlled, three-centre feasibility study to compare the effectiveness and cost of the Therabite® and wooden spatulas. We studied compliance with exercises and health-related QoL, assessed cost using three health economics measures, and conducted semistructured interviews with patients. Patients were randomised into two groups: the Therabite® group (n = 37) and the wooden spatula group (n = 34). All patients had some sense of jaw tightening before the study started. Mean mouth opening after six months increased in both groups, but the difference between the groups was not significant (p = 0.39). Completion rates for the three economic measures were good. There was no significant difference between the two groups in frequency of contact with care services or in QoL. Exercises during and after radiotherapy can ameliorate trismus in patients with stage three and four oral and oropharygeal cancers, but differences between groups in efficacy, compliance, QoL, or use of hospital or community health services, were not significant.
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