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. 2019 Mar;27(3):1129-1137.
doi: 10.1007/s00520-018-4402-z. Epub 2018 Aug 14.

Criterion for trismus in head and neck cancer patients: a verification study

Sarah J van der Geer  1 , Phillip V van Rijn  2 , Jolanda I Kamstra  2 , Jan L N Roodenburg  2 , Pieter U Dijkstra  2   3
Affiliations

Criterion for trismus in head and neck cancer patients: a verification study

Sarah J van der Geer et al. Support Care Cancer. 2019 Mar.

Abstract

Purpose: Several cut-off points for trismus in head and neck cancer patients have been used. A mouth opening of 35 mm or less is most frequently used as cut-off point. Due to the variation in cut-off points, prevalence, risk factors and treatment outcomes of trismus cannot be studied in a uniform manner. To provide uniformity, we aimed to verify the cut-off point of 35 mm or less. Additionally, we aimed to determine associated covariates with reported difficulties when opening the mouth.

Methods: In a cross-sectional design, we measured the mouth opening in 671 head and neck cancer patients at the Department of Oral and Maxillofacial Surgery, at the University Medical Center Groningen. The cut-off point was determined using the receiver operating characteristic curve and Youden index, with reported difficulties when opening the mouth as criterion for trismus. Cut-off points for significant covariates were also determined.

Results: The Youden index was highest at 35 mm, with a sensitivity of 0.71 and a specificity of 0.86. Of the covariates analysed, type of treatment modality was significantly associated with reported difficulties when opening the mouth. The highest Youden index for patients treated with surgery alone was 37 mm and for patients treated with radiotherapy alone 33 mm.

Conclusions: The cut-off point of 35 mm or less for trismus was confirmed in a head and neck cancer population and is recommended to be used in future studies. Patients receiving different treatment modalities experience difficulty when opening the mouth differently.

Keywords: Head and neck neoplasms; Mouth neoplasms; Quality of life; Range of motion, articular; Surgery, oral; Trismus.

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Conflict of interest statement

Research involving human participants and/or animals

Retrospective study: for this type of study formal consent is not required.

The Medical Ethical Committee of the UMCG concluded that our research was not subject to the Medical Research (Human Subject) Act (METc number 2016.692).

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

Conflict of interest

None declared.

Data

Corresponding author has full control of all primary data.

Corresponding author allows the journal to review the data if requested.

Figures

Fig. 1
Fig. 1
Box-and-whisker plots concerning maximum mouth opening in relation to patients’ perception of experiencing difficulties opening the mouth. a Total study population, b patients treated with surgery only, c patients treated with radiotherapy only
Fig. 2
Fig. 2
Receiver operating characteristic curve comparing maximum mouth opening (mm) with reported difficulties opening the mouth. a ROC curve for the total study population. Area under the curve: 0.846 (95% CI 0.803 to 0.889). b ROC curve for surgery only. Area under the curve: 0.784 (95% CI 0.667 to 0.901). c ROC curve for radiotherapy only. Area under the curve: 0.811 (95% CI 0.705 to 0.917)
See this image and copyright information in PMC

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