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Trismus in head and neck cancer patients in Sweden: incidence and risk factors.

Journal article
Authors Joakim Johnson
Corina J van As-Brooks
Bodil Fagerberg-Mohlin
Caterina Finizia
Published in Medical science monitor
Volume 16
Issue 6
Pages CR278-82
ISSN 1234-1010
Publication year 2010
Published at Institute of Odontology
Institute of Clinical Sciences, Department of Otorhinolaryngology
Pages CR278-82
Language en
Keywords Adult, Aged, Aged, 80 and over, Female, Head and Neck Neoplasms, complications, pathology, Humans, Incidence, Male, Middle Aged, Radiation Injuries, Radiation Oncology, methods, Radiotherapy Dosage, Retrospective Studies, Risk Factors, Sweden, Treatment Outcome, Trismus, diagnosis, epidemiology, etiology
Subject categories Otorhinolaryngology


BACKGROUND: The aim was to retrospectively investigate trismus (reduced mandible mobility) development in specified head and neck (H&N) cancer diagnosis according to different radiotherapy dosage regimens. MATERIAL/METHODS: Sixty-nine out of 246 patients with different H&N cancer diagnoses and available maximum interincisal opening (MIO) measurements before and after treatment were analyzed according to age, gender, radiation dose, tumor site and stage, and Karnofsky Performance Status Scale index. MIO was measured over time (range: 3-48 months), with a cutoff criterion for trismus of 35 mm. RESULTS: Overall, 42% of the patients had post-treatment MIO <35 mm, and trismus incidence was highest in patients treated for parotid gland tumors followed by those treated for nasopharyngeal cancers. The mean MIO values at baseline were significantly different (p=0.0078) between patients who developed trismus (i.e. MIO <35 mm; mean: 43 mm) and those who did not (mean: 51 mm). The trismus patients also had significantly larger tumors (p=0.0437), poorer physical function before start of treatment (p=0.0344), and had more often received a higher total tumor radiation dose (p=0.0418). CONCLUSIONS: This study reports a high incidence of trismus in H&N cancer patients after treatment. Furthermore, it was found that poor physical function before the start of treatment and high external beam radiation therapy (EBRT) dosages (>50 Gy) were related to significantly more trismus. Future prospective studies are needed to provide a better understanding of different risk factors associated with trismus development, the impact on health-related quality of life, and the effects of early treatment.

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