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. 2017 Jul;274(7):2695-2707.
doi: 10.1007/s00405-017-4519-6. Epub 2017 Mar 25.

Trismus following different treatment modalities for head and neck cancer: a systematic review of subjective measures

Sook Y Loh  1 , Robert W J Mcleod  2 , Hassan A Elhassan  2
Affiliations

Trismus following different treatment modalities for head and neck cancer: a systematic review of subjective measures

Sook Y Loh et al. Eur Arch Otorhinolaryngol. 2017 Jul.

Abstract

The aim of this review was to compare systematically the subjective measure of trismus between different interventions to treat head and neck cancer, particularly those of the oropharynx. Using The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Guidelines, Six databases were searched for the text using various terms which include "oropharyngeal/head and neck cancer", "trismus/mouth opening" and the various treatment modalities. Included in the review were clinical studies (> or =10 patients). Three observers independently assessed the papers identified. Among the six studies reviewed, five showed a significantly worst outcome with regard to the quality-of-life questionnaire scores for a radiotherapy or surgery and radiotherapy (RT) ± chemotherapy or chemoradiotherapy when compared to surgery alone. Only one study showed no significant difference between surgery alone and other treatment modalities. Subjective quality-of-life measures are a concurrent part of modern surgical practice. Although subjective measures were utilised to measure post operative trismus successfully, there was no consensus as to which treatment modality had overall better outcomes, with conflicting studies in keeping with the current debate in this field. Larger and higher quality studies are needed to compare all three treatment modalities.

Keywords: Chemotherapy; Oropharyngeal carcinoma; Quality of life; Radiotherapy; Surgery; Trismus.

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Conflict of interest statement

Funding

The authors did not receive any financial support or other external help in preparing this manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Trismus search strategy to obtain literature using PRISMA guidelines
Fig. 2
Fig. 2
Algorithm for measuring trismus in future studies. Assessment to include the following: Objective use callipers or similar instrument to measure the inter-incisor distance. Document in patient notes and/or database. Subjective use questionnaire (EORTC QLQ-C-30 and EORTC QLQ-H&N35) to score patients’ reported perception of trismus. Questionnaire added to patients’ notes and/or database
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