From the Guidelines
Initial management of trismus post radiation oncology treatment should involve a multimodal approach centered on physical therapy and mechanical stretching, with referral to rehabilitation specialists and dental professionals to prevent trismus and treat it as soon as it is diagnosed, as recommended by the most recent guidelines 1.
Key Components of Management
- Referral to rehabilitation specialists and dental professionals for comprehensive management
- Use of custom mouth opening devices to maintain range of motion, as suggested by guidelines 1
- Jaw stretching exercises 3-5 times daily using devices like the TheraBite or OraStretch jaw motion rehabilitation systems, or simple stacked tongue depressors
- Pain management with NSAIDs like ibuprofen or acetaminophen before exercises to improve compliance
Goals of Management
- Maintain a mouth opening of at least 35mm to preserve function for eating, speaking, and oral hygiene
- Prevent trismus and minimize its impact on quality of life
- Regular follow-up every 2-4 weeks initially to monitor progress and adjust the treatment plan as needed, with adjustments based on the latest clinical practice guidelines 1
Importance of Early Intervention
Early intervention is crucial as radiation-induced fibrosis progressively worsens over time, making later treatment more difficult, highlighting the need for prompt referral and management as outlined in recent systematic reviews 1.
From the Research
Initial Management for Trismus Post Radiation Oncology Treatment
The initial management for trismus (lockjaw) post radiation oncology (ROC) treatment involves a multidisciplinary approach.
- Exercise therapy is the mainstay of treatment and should start as soon as possible after treatment 2.
- The use of intensity-modulated RT seems to lower the percentage and severity of RT-induced trismus 2.
- Treatment of trismus can be conservative (with either medical or physical therapy) or surgical 2.
- Jaw-mobilizing devices can be used to manage trismus, with within-group comparisons supporting their benefit 3.
- Physical therapy, pain medications, and botulinum toxin injections can be used as part of a multimodal treatment strategy for trismus 4.
- A dynamic jaw opening device, such as the Dynasplint Trismus System, can be an effective component of a multimodal strategy for improving trismus associated with head and neck cancer and its treatment 4.
Key Considerations
- Trismus may worsen or remain the same over time, or the symptoms may reduce, even in the absence of treatment 2.
- Restricted mouth opening may impede inspection of the oral cavity as needed for dental care, and particularly for oncologic follow-up 2.
- The prevention of trismus, rather than its treatment, is the most important objective 2.
- Survivor symptoms and intervention burden were reported reasons for poor adherence and completion rates 3.