title: Trismus in patients with head and neck cancer: etiopathogenesis, diagnosis and management.
abstract: BACKGROUND
  Trismus indicates severely restricted mouth opening of any aetiology. A mouth opening of 35 mm or less should be regarded as trismus. Aim of this study was to review the etiopathogenesis, incidence, treatment and prevention of trismus in patients with head and neck cancer.
  
  
  OBJECTIVE
  Trismus is frequently seen in patients suffering from malignant tumours of the head and neck. The reported prevalence of trismus in those patients varies considerably in the literature and ranges from 0 to 100% depending on the tumour site and extension. Trismus may worsen or remain the same over time, or the symptoms may reduce, even in the absence of treatment. When a patient presents with trismus after tumour treatment, it is important to determine whether the trismus is the result of the treatment, or is the first sign of a recurrence. Restricted mouth opening may impede inspection of the oral cavity as needed for dental care, and particularly for oncologic follow-up.
  
  
  CONCLUSIONS
  Mouth opening after radiotherapy (RT) decreases on average by approximately 20% compared to mouth opening prior to RT. The prevalence of trismus increases with increasing doses of RT to mastication structures. The use of intensity-modulated RT seems to lower the percentage and severity of RT-induced trismus. Treatment of trismus can be conservative (with either medical or physical therapy) or surgical. Exercise therapy is the mainstay of treatment and exercise should start as soon as possible after treatment. The prevention of trismus, rather than its treatment, is the most important objective.
authors.affiliation: Department of Head and Neck Surgery, Greek Anticancer Institute, Saint Savvas Hospital, Athens, Greece.
authors.forename: A D
authors.initials: AD
authors.lastname: Rapidis
authors.affiliation: Center for Rehabilitation & Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: P U
authors.initials: PU
authors.lastname: Dijkstra
authors.affiliation: Department of Oral and Maxillofacial Surgery, Section of Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: J L N
authors.initials: JL
authors.lastname: Roodenburg
authors.affiliation: Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.|Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.
authors.forename: J P
authors.initials: JP
authors.lastname: Rodrigo
authors.affiliation: University of Udine School of Medicine, Udine, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Rinaldo
authors.affiliation: Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
authors.forename: P
authors.initials: P
authors.lastname: Strojan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: R P
authors.initials: RP
authors.lastname: Takes
authors.affiliation: University of Udine School of Medicine, Udine, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ferlito
mesh_terms: D019468:Disease Management; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D015995:Prevalence; D014313:Trismus / Q000175:diagnosis / Q000209:etiology / Q000628:therapy