Radiation Induced Trismus:
Incidence: 35-55% of patients develop trismus, highest for patients of oral and nasal cancer. Incidence increases significantly with higher radiation or after second courses of radiation therapy.
Progression: Dramatic losses begin in the first 3 to 12 months AFTER radiation, with continuing loss for 24-48+ months. Prevention: Trismus can be very difficult to treat, especially when caused by radiation. Preventing its development is imperative for the long-term functionality and quality of the patients recovery.
Therapy and stretching are less effective in treating radiation induced trismus after it has occurred.
Trismus (<35mm MIO) at discharge of radiation therapy is strong predictor of trismus at 6 months.
Preventative early rehabilitation can reduce incidence (by 40%) and severity (by 60%) of trismus. Trismus Therapy Expectations:
Recovery depends on patient’s commitment to rehabilitation. Radiation fibrosis is progressive and very difficult to rehab.
Pain: Patients may experience dull pain in first days of beginning therapy. Like soreness after a new workout. No sharp pain.
Post-Stretching Gains: 1-4 mm immediately. Long-term Gains: 1-2 mm overall ROM, per week.
Approximate estimates. Not possible for all patients. Results will vary. Complications of Radiation Induced Fibrosis and Trismus:
- Reduced Oral Hygiene and Saliva promote dental decay and integrity of mandible.
- Disruption of Cancer Treatments
- Compromised Airway, Aspiration
- Reduced Quality of Life:
- Voice, Speech problems (68%)
- Difficulty Sneezing, Laughing
- Reduced social interaction
- Dysphagia, Eating, drinking (65-73%)
- Malnutrition and Dehydration
- Reduced Oral Access, for:
- Dentures/Prosthetics
- Dental Procedures
- Medical Procedures, Intubation
- Joint Immobilization (oral cancer 73%):
- Muscle contracture and atrophy
- Muscle and joint degradation
- Inflammation, pain, fatigability.
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