Journal of
eISSN: 2379-6359
Submit manuscript...
Letter to Editor Volume 14 Issue 1
Rehabilitation management of trismus in head and neck cancer patients
Dr. Ankita Patel, Dr. Gaurav Goswami, Dr. Neha Gupta, Dr. Deepak Kumar Singh, Dr. Soumyashree Samantaray, Deepika Shukla, Preeti Singh, Dibyendu Roy
Verify Captcha
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.
Verify Captcha
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.
Apex Superspeciality Hospital, India
Correspondence: Dr. Dibyendu Roy, Department of Onco Rehabilitation, Apex Super specialty Hospital, Varanasi, India
Received: May 16, 2022 | Published: June 3, 2022
Citation: Patel A, Goswami G, Gupta N, et al. Rehabilitation management of trismus in head and neck cancer patients. J Otolaryngol ENT Res. 2022;14(1):30 DOI: 10.15406/joentr.2022.14.00501
Letter to Editor
Trismus is known as the Painful restriction in the opening of mouth due to spasm of masticatory muscles.1 Normal mouth opening ranges between 35-45 mm. In male the mouth opening is some time much than females (40-60mm).2 It’s a common and debilitating complication in head and neck cancer and its treatment. The trismus can cause negative effects in Nutrition, Phonation, Dental hygiene, treatment and quality of life. It can cause Pain in the Temporo mandibular joint and it can cause headache in some conditions.3
Surgery of Mandible i.e hamimandibulectomy, mandibulectomy, Zygomatic arch, Zygomatic arch complex, Tongue (Glossectomt) can cause trismus. When the masticatory muscles are within the field of Radiation it can cause the fibrosis and leads to trismus. Due to poor hygiene of mouth and toxic effect of Chemotherapy ultimately leads to Oral Mucositis, Stomatitis, Glossitis . This condition can cause dysphagia and it increases the Overall Treatment Time (OTT).4 Proper Oro Facial Exercises, Temporo mandibular Joint (TMJ) Mobilization can increase the mouth opening. Photobiomodulation Therapy (PBM) can decrease the pain in the TMJ.
Use of Photobiomodulation (PBM) in Trismus management
We can use PBM as Prophylactic and Therapeutic. PBM can be used extra-orally and intra-orally. When the patient is on Radiation therapy or Chemo-Radiation Therapy PBM can be used Bilaterally over Pterygoid, Masseter, Buccinators muscles or Temporomandibular joint (Extra-orally) and over the Pterygomandibular Raphae (Intra-orally). The Extra-oral dose (Prophylactic) will be 750-830nm, 20mW/cm2- 80mW/cm2. The intra-oral dose (Prophylactic) will be 630-680 nm, 20mW/cm2-200mW/cm2.5
It will be easier to mobilize the Temporo mandibular Joint (TMJ) when there is less pain. Ultimately when the patient’s mouth opening and tongue movements are sufficient, patients can maintain their proper oral hygiene, can have sufficient food. The Grade of Oral Mucositis will be less, Pain score will be less and the incidence of Dysphagia will be less which ultimately helps to maintain proper weight and blood counts during Chemo Radiation Therapy. The Quality of Life will be good for the Cancer survivors will be improved a lot. Psychologically patients will be in a good state.
Acknowledgments
None.
Funding
None.
Conflicts of interest
No conflict of interest.
References
- Miller-Keane and Marie T O'Toole. Miller-Keane Encyclopedia and Dictionary of Medicine. Nursing, and Allied Health. 2003.
- Newlands, Cyrus Kerawala, Carrie. Oral and maxillofacial surgery. 2010
- Wranicz p, Herlofson BB, Evensen JF, et al. Prevention and treatment of trismus in head and neck cancer: A case report and a systematic review of the literature. Scand J Pain. 2010;1(2):84–88.
- Hupp JR, Ellis E, Tucker MR. Contemporary oral and maxillofacial surgery (5th ed.). Elseveir. 2008.
- Goldstein M, Maxymiw WG, Cummings BJ, et al. The effects of antitumor irradiation on mandibular opening and mobility: a prospective study of 58 patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88(3):365–373.
©2022 Patel, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.