Trismus in head and neck cancer: translation and validation of the Chinese version of the Gothenburg Trismus Questionnaire-2 (C-GTQ-2).

OBJECTIVES: Trismus, marked by restricted mouth opening, significantly affects patients with temporomandibular disorder (TMD) and head and neck cancer (HNC). Despite its prevalence, specialized questionnaires for trismus assessment are scarce. This study aims to fill this gap by translating and validating the Gothenburg Trismus Questionnaire version 2 (GTQ-2) into Chinese (C-GTQ-2), enhancing the evaluation of trismus in HNC and TMD patients. MATERIALS AND METHODS: The study involved 78 HNC patients, 75 TMD patients, and a control group of 150 individuals without trismus symptoms. Participants were asked to complete the C-GTQ-2 and other health-related quality of life (HRQL) instruments. A subset of 30 individuals retook the questionnaire within two weeks to assess test-retest reliability. RESULTS: The C-GTQ-2 demonstrated remarkable reliability, with Cronbach's alpha values exceeding 0.70 in three of the four domains, indicating high internal consistency. The instrument also showcased high intra-class correlations in the test-retest, affirming its reliability. Furthermore, it exhibited strong convergent validity, aligning well with other HRQL instruments, and effectively discriminated between patients with and without trismus, establishing its discriminant validity. CONCLUSIONS: The C-GTQ-2 emerges as a valid and reliable tool for assessing trismus in HNC and TMD patients, promising to significantly enhance both clinical and research approaches to managing trismus-related complications in the Chinese-speaking demographic. CLINICAL RELEVANCE: C-GTQ-2 proves effective for trismus assessment in head and neck cancer and temporomandibular disorder patients, offering enhanced clinical and research utility.

Exercise therapy for cancer treatment-induced trismus in patients with head and neck cancer: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Trismus is a common complication of cancer treatment, particularly radiotherapy, for head and neck cancer. We investigated whether exercise therapy could prevent or manage limited mouth opening in patients before or after the cancer treatment. METHODS: We performed a systematic review and meta-analysis to evaluate the effectiveness of exercise therapy combined with a jaw-mobilizing device in the prevention and treatment of cancer treatment-induced trismus. The electronic databases PubMed, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were searched for articles on trismus published before July 2020 with no language restrictions. The primary outcome for prevention was trismus incidence. The treatment outcome for trismus was the improvement of maximal interincisal opening (MIO). RESULTS: Thirteen randomized controlled trials (RCTs) involving 733 patients were identified. Six studies assessed MIO and found that exercise therapy adjuvant to the use of a jaw-mobilizing device significantly improved the MIO from 4.48 (95% confidence interval [CI] = 0.20, 8.75) to 14.20 (95% CI = 10.73, 17.67) mm. Seven studies evaluating the preventive outcome of incidence of trismus found no significant difference between standard usual care and exercise therapy adjuvant to the use of a jaw-mobilizing device (risk ratio = 1.20; 95% CI = 0.61, 2.34). CONCLUSIONS: The current evidence from RCTs revealed that exercise therapy can lead to MIO improvement following the development of cancer treatment-induced trismus, but does not prevent trismus in patients being treated for head and neck cancer. The clinical exercise programs used in the studies were heterogeneous; therefore, additional high-quality RCTs are required.