Developing and Validating an Intelligent Mouth-Opening Training Device: A New Solution for Restricted Mouth Opening.

Restricted mouth opening (trismus) is one of the most common complications following head and neck cancer treatment. Early initiation of mouth-opening exercises is crucial for preventing or minimizing trismus. Current methods for these exercises predominantly involve finger exercises and traditional mouth-opening training devices. Our research group successfully designed an intelligent mouth-opening training device (IMOTD) that addresses the limitations of traditional home training methods, including the inability to quantify mouth-opening exercises, a lack of guided training resulting in temporomandibular joint injuries, and poor training continuity leading to poor training effect. For this device, an interactive remote guidance mode is introduced to address these concerns. The device was designed with a focus on the safety and effectiveness of medical devices. The accuracy of the training data was verified through piezoelectric sensor calibration. Through mechanical analysis, the stress points of the structure were identified, and finite element analysis of the connecting rod and the occlusal plate connection structure was conducted to ensure the safety of the device. The findings support the effectiveness of the intelligent device in rehabilitation through preclinical experiments when compared with conventional mouth-opening training methods. This intelligent device facilitates the quantification and visualization of mouth-opening training indicators, ensuring both the comfort and safety of the training process. Additionally, it enables remote supervision and guidance for patient training, thereby enhancing patient compliance and ultimately ensuring the effectiveness of mouth-opening exercises.

Fotobiomodulação no tratamento do trismo em pacientes tratados por câncer de boca ou orofaringe: um ensaio clínico controlado randomizado / Photobiomodulation in the treatment of trismus in patients treated for oral or oropharyngeal cancer: a randomized controlled clinical trial

RESUMO Objetivo investigar a eficácia da associação entre a fotobiomodulação de baixa frequência e a terapia fonoaudiológica tradicional no tratamento do trismo, em pacientes tratados por câncer de boca ou orofaringe. Métodos ensaio clínico controlado, randomizado, longitudinal e prospectivo, realizado de acordo as normas da declaração CONSORT 2010. Para a coleta de dados, foi utilizado o questionário sociodemográfico, a avaliação clínica, a mensuração da abertura de boca por paquímetro, o protocolo de dor McGuill e o protocolo de qualidade de vida WHOQOL-Bref. A amostra foi composta por 30 participantes, de ambos os gêneros na faixa etária de 35-75 anos, divididos em dois grupos, controle e experimental, de forma controlada, mediante sorteio igualitário no que tange aos critérios de inclusão e exclusão. Resultados por meio dos dados analisados, observou-se que houve aumento da amplitude vertical de mandíbula em ambos os grupos, GC: p<0,005 e GE: p<0,001. Não houve correlação estatística entre os grupos na comparação da abertura de boca, p>0,19, assim como em relação à dor orofacial e à qualidade de vida, p= 0,72, ambas as avaliações após a intervenção fonoaudiológica, porém, com melhores resultados para o GE, p<0,001. Conclusão Conclui-se pela eficácia da intervenção fonoaudiológica tradicional e a associação com a fotobiomodulação de baixa frequência no tratamento do trismo. Para a dor orofacial e qualidade de vida, o tratamento associado é mais benéfico.

ABSTRACT Purpose to investigate the effectiveness of the association between low-frequency photobiomodulation and traditional speech therapy in the treatment of trismus in patients treated for oral or oropharyngeal cancer. Methods controlled, randomized, longitudinal and prospective clinical trial, carried out in accordance with the norms of the CONSORT 2010 declaration. For data collection, a sociodemographic questionnaire, clinical evaluation, measurement of mouth opening by caliper, the protocol of McGuill pain and the WHOQOL-Bref quality of life protocol. The sample consisted of 30 participants, of both genders, aged between 35-75 years, divided into two groups, control and experimental, in a controlled manner, through an equal draw with regard to the inclusion and exclusion criteria. Results through the analyzed data, it was observed that there was an increase in the vertical amplitude of the mandible in both groups, CG: p0.19, as well as in relation to orofacial pain and quality of life, p= 0.72, both assessments after the speech therapy intervention, however, with better results for the EG, p<0.001. Conclusion It is concluded that the traditional speech therapy intervention and its association with low-frequency photobiomodulation are effective in the treatment of trismus. For orofacial pain and quality of life, associated treatment is more beneficial.

The role of the speech and language therapist in the rehabilitation of speech, swallowing, voice and trismus in people diagnosed with head and neck cancer.

Head and neck cancer (HNC) and its treatment can have a significant impact on physical and psychosocial wellbeing. A multidisciplinary team (MDT) approach is critical to reduce the potential acute, long-term and late effects of treatment by optimising function at baseline, supporting people during treatment and with rehabilitation post treatment. The key focus for speech and language therapists is to support the holistic needs of people with a focus on speech, swallowing, voice and mouth opening. Effective management is reliant on working with MDT members and interventions are implemented against the background of robust multidimensional baseline evaluation. There have been significant advances in treatment modalities for both primary and recurrent HNC. These include highly conformal radiotherapy modalities, including: image-guided radiotherapy; parotid-sparing and dysphagia-optimised intensity-modulated radiotherapy; and the introduction of intensity-modulated proton therapy, as well as immunotherapy, transoral robotic surgery and surgery with advanced reconstructive techniques. Such treatment advances coupled with a changing patient demographic means that people with HNC are now living longer. However, this is not always without consequences and late treatment effects are a new challenge facing MDTs, requiring high levels of support and rehabilitation.

Trismus therapy devices: A systematic review.

BACKGROUND: There is a wide range of commercial and custom-made devices available for the treatment of trismus (restricted jaw opening). They are used often in conjunction with a prescribed exercise program with the aim of improving maximal inter-incisal opening (MIO). This study compared the efficacy (MIO and patient reported outcome results), adverse events, consumer experience and cost of the different types of devices available. METHODS: Four databases were searched between the years 2001-2021 using the terms 'trismus' and 'device'. Two independent authors assessed each paper for inclusion, then conducted a quality analysis. RESULTS: Thirty-two studies met the criterion required for inclusion. The majority (n = 27) were in the context of established trismus, where the remaining five used the device preventatively. The trismus device improved MIO in 23 of the rehabilitation programs (pooled mean MIO increased by 9.5 mm in the intervention arm compared to 2.4 mm for controls; p = 0.0001). Improved MIO was not observed in the prevention studies. The Therabite ® was the most common trismus device investigated and with a mean increase in MIO of 10.0 mm and cost of $499AUD. Forces applied by trismus devices were regulated by the perception of pain experienced by the patient, rather than a prescribed force by the treating health professional. Despite this guidance, several adverse events occurred (n = 8), including mandibular and molar fractures. Barriers experienced by consumers included pain, ill-fitting mouthpiece, adverse events, exercise adherence and cost. CONCLUSION: Trismus devices which use the application of force to the jaw can improve the MIO of patients with established trismus. However, their role is unproven in the setting of trismus prevention during radiotherapy and several significant barriers such as cost, exercise adherence and safety concerns have been demonstrated for the intervention setting.

The effect of kinesio taping with the web strip technique on pain, edema, and trismus after impacted mandibular third molar surgery.

BACKGOUND: There are many methods used to alleviate edema, trismus, and pain after impacted third molar (3M) removal, one of which is Kinesio Taping (KT). AIMS: This study aimed to evaluate the effectiveness of Kinesio Taping with Web Strip technique on postoperative morbidity after impacted mandibular 3M extraction. METHODS: The study employed a split-mouth and controlled randomized clinical trial design. A total of 60 patients were scheduled for surgical extractions of bilateral lower 3Ms. They were randomly divided into two groups, and KT was applied to one group while the others was determined as a control group without KT application. Tape was applied directly after surgery and maintained for postoperative (post-op) 7 days. Pain intensity was recorded subjectively using a Visual Analogue Scale (VAS). Pain and analgesic usage were recorded on the post-op 1st, 2nd, 3rd, and 7th days. Trismus was evaluated before the surgery and on the post-op 2nd and 7th days. Facial edema was analyzed on the post-op 2nd and 7th days by VAS and by measuring the lengths of three lines using a flexible plastic tape measure. RESULTS: VAS pain scores were statistically lower in the KT group on the post-op 1st, 3rd and 7th days. Total analgesic usage was also significantly lower in the KT group. On the post-op 2nd day, measurement of the lengths of three lines showed a statistically less edema in the KT group. Similar results were obtained from the measurement of edema using VAS. Maximum mouth opening was statistically higher in the KT group on the post-op 2nd and 7th day. CONCLUSION: KT with the web strip technique should be considered more economic and less traumatic than other approaches, as it is free from systemic side effects and is a simple method to carry out to decrease morbidity.

Mouth-opening device as a treatment modality in trismus patients with head and neck cancer and oral submucous fibrosis: a prospective study.

OBJECTIVES: This study investigated the clinical effectiveness of intervention with an open-mouth exercise device designed to facilitate maximal interincisal opening (MIO) and improve quality of life in patients with head and neck (H&N) cancer and oral submucous fibrosis (OSF). MATERIALS AND METHODS: Sixty patients with H&N cancer, OSF, and trismus (MIO < 35 mm) participated in the functional rehabilitation program. An open-mouth exercise device intervention group and conventional group, each consisting of 20 patients, underwent a 12-week training and exercising program and follow-up. For the control group, an additional 20 patients were randomly selected to match the demographic characteristics of the aforementioned two groups. RESULTS: The patients' MIO improvements in the aforementioned three groups were 14.0, 10.5, and 1.3 mm, respectively. CONCLUSION: Results of this study confirm the significant improvement in average mouth-opening range. In addition, according to patient feedback, significant improvements in health-related quality of life and reductions in trismus symptoms occurred in the open-mouth exercise device group. CLINICAL RELEVANCE: This newly designed open-mouth exercise device can facilitate trismus patients with H&N cancer and OSF and improve mouth-opening range and quality of life.

Speech-language therapy program for mouth opening in patients with oral and oropharyngeal cancer undergoing adjuvant radiotherapy: a pilot study. / Programa terapêutico fonoaudiológico para abertura de boca em pacientes com câncer de boca e orofaringe em radioterapia adjuvante: estudo piloto.

Purpose Assess the effectiveness of an orofacial myofunctional therapeutic program in patients with oral or oropharyngeal cancer submitted to adjuvant radiotherapy through pre- and post-program comparison of maximum mandibular opening. Methods Prospective study involving five adult patients and five elderly patients postoperatively to oral cavity/oropharynx surgery who were awaiting the beginning of radiotherapy or had undergone fewer than five treatment sessions. The study participants had their maximum jaw opening measured using a sliding caliper at the beginning and end of the program. Two mobility exercises and three mandibular traction exercises were selected and weekly monitored presentially for 10 weeks. Descriptive data and pre- and post-therapy comparative measures were statistically analyzed using the Wilcoxon test. Results Ten patients (two women and eight men) with mean age of 58.4 years, median of 57.0 years, completed the therapeutic program. They presented mean maximum mandibular opening of 31.6 ± 11.7 and 36.4 ± 8.0 mm pre- and post-therapy, respectively (p =0.021). Conclusion The proposed orofacial myofunctional therapeutic program increased the maximum jaw opening of patients referred to adjuvant radiotherapy for oral cavity or oropharynx cancer treatment.

Programa terapêutico fonoaudiológico para abertura de boca em pacientes com câncer de boca e orofaringe em radioterapia adjuvante: estudo piloto / Speech-language therapy program for mouth opening in patients with oral and oropharyngeal cancer undergoing adjuvant radiotherapy: a pilot study

RESUMO Objetivo Analisar, por meio da comparação entre a abertura máxima mandibular, a efetividade de programa terapêutico miofuncional oral em pacientes com câncer de boca ou orofaringe submetidos à radioterapia adjuvante. Método Estudo prospectivo envolvendo cinco pacientes adultos e cinco idosos em pós-operatório de cirurgia de boca/orofaringe que aguardavam início da radioterapia ou até a quinta sessão. No início e no final do programa, os participantes tiveram suas medidas de abertura máxima mandibular mensuradas por meio de paquímetro e foram selecionados cinco exercícios - dois de mobilidade e três de tração mandibular - com controle presencial durante oito semanas, perfazendo um total de dez semanas. Dados descritivos e a comparação das medidas pré e pós-fonoterapia por meio do teste de Wilcoxon foram considerados na análise dos dados. Resultados Dez pacientes finalizaram o programa terapêutico (duas mulheres e oito homens), com média de idade de 58,4 anos, mediana de 57,0 anos. Apresentaram média de abertura máxima mandibular de 31,6 ± 11,7 mm antes do tratamento e 36,4 ± 8,0 mm no pós-terapia (p=0,021). Conclusão O programa terapêutico miofuncional oral proposto promoveu aumento da abertura máxima vertical da mandíbula de pacientes submetidos à radioterapia e/ou quimioterapia adjuvante para tratamento de câncer de boca e orofaringe.

ABSTRACT Purpose Assess the effectiveness of an orofacial myofunctional therapeutic program in patients with oral or oropharyngeal cancer submitted to adjuvant radiotherapy through pre- and post-program comparison of maximum mandibular opening. Methods Prospective study involving five adult patients and five elderly patients postoperatively to oral cavity/oropharynx surgery who were awaiting the beginning of radiotherapy or had undergone fewer than five treatment sessions. The study participants had their maximum jaw opening measured using a sliding caliper at the beginning and end of the program. Two mobility exercises and three mandibular traction exercises were selected and weekly monitored presentially for 10 weeks. Descriptive data and pre- and post-therapy comparative measures were statistically analyzed using the Wilcoxon test. Results Ten patients (two women and eight men) with mean age of 58.4 years, median of 57.0 years, completed the therapeutic program. They presented mean maximum mandibular opening of 31.6 ± 11.7 and 36.4 ± 8.0 mm pre- and post-therapy, respectively (p =0.021). Conclusion The proposed orofacial myofunctional therapeutic program increased the maximum jaw opening of patients referred to adjuvant radiotherapy for oral cavity or oropharynx cancer treatment.

Impact of exercise with TheraBite device on trismus and health-related quality of life: A prospective study.

Trismus is a common symptom in patients with head and neck cancer that affects many aspects of daily life negatively. The aim of this study was to investigate the impact of structured exercise with the jaw-mobilizing device TheraBite on trismus, trismus-related symptomatology, and health-related quality of life (HRQL) in patients with head and neck cancer. Fifteen patients with trismus (maximum interincisal opening [MIO] ≤35 mm) after oncologic treatment for head and neck cancer, underwent a 10-week exercise program with the TheraBite device and were followed regularly. Time between oncologic treatment and start of TheraBite exercise ranged from 0.7 to 14.8 years (average 6.2 years). MIO, trismus-related symptoms, and HRQL was assessed before and after exercise and after 6 months. A significant improvement in MIO was observed post-exercise (3.5 mm, 15.3%, p = 0.0002) and after 6-month of follow-up (4.7 mm, 22.1%, p = 0.0029). A statistically significant correlation was found between increased MIO and fewer trismus-related symptoms. In conclusion, exercise with TheraBite improved MIO and trismus-related symptoms in patients with trismus secondary to head and neck cancer. Structured exercise with the jaw-mobilizing device seems to be beneficial for patients with trismus independent of time since oncologic treatment.

Trismus in head and neck cancer patients treated by telecobalt and effect of early rehabilitation measures.

CONTEXT: Trismus is one of the common late side effects of radiotherapy (RT) of head and neck cancers. It occurs in about 30% of patients treated by telecobalt. It, in turn, leads to significant morbidity, including malnutrition, difficulty in speaking, and compromised oral hygiene with severe psychosocial, and economic impacts. AIMS: To determine the prevalence of trismus and its progression in patients who have received radical concurrent chemoradiation for head and neck cancer by telecobalt at our institution. To note the effect of early rehabilitative measures on the severity of trismus and to assess its impact on the quality of life (QOL). SUBJECTS AND METHODS: A total of 47 evaluable patients of head and neck cancer patients treated by telecobalt with radical intent between January 2012 and December 2013 were analyzed and baseline maximal inter-incisal opening (MIO) and MIO at the completion of RT, after 3 months, 6 months, and 1 year, after completion of RT were noted. Grading of trismus was done using Modified Common Toxicity Criteria (CTCAE Version 3.0). QOL assessment was done using European Organization for Research and Treatment of Cancer QLQ-HN35. The time when the rehabilitative measures were started were also noted. STATISTICAL ANALYSIS USED: Chi-square test with Fisher exact probability test and Students t-test. RESULTS: Radiation-induced trismus (RIT) was seen in 31.9%, 34.04%, and 38.39% of cases at 3, 6, and 12 months after completion of RT. Grade II and III trismus accounted for 17.02% and 6.38% at the end of 1 year. Patients who started regular rehabilitative exercises soon, after completion of RT had a better mean MIO as compared to those who were not compliant (32 mm vs. 24 mm at 1 year), and there was a trend toward delayed progression in them. Trismus was also seen to adversely affect QOL of the patients. CONCLUSIONS: RIT is a major cause for late morbidity in patients treated with conventional RT leading to poor QOL. Early rehabilitative measures are useful in preventing progression of trismus.

Exercise intervention for the treatment of trismus in head and neck cancer - a prospective two-year follow-up study.

Background This study aims to investigate the long-term effects of structured trismus intervention in patients with head and neck cancer (HNC) and trismus in terms of mouth opening, trismus-related symptoms and health-related quality of life (HRQL). Material and methods Fifty patients with HNC to receive radiotherapy ± chemotherapy were included in this prospective study along with a matched control group. The intervention group received a 10-week structured exercise with a jaw mobilizing device (TheraBite® jaw device or Engström device). Patients were assessed before and after trismus exercise intervention and at a two-year follow-up. Primary endpoint was maximum interincisal opening (MIO) and secondary endpoints included trismus-related symptoms and HRQL assessed with patient-reported outcome (PRO)-instruments [Gothenburg Trismus Questionnaire (GTQ), European Organization for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) and the related HNC-specific module the EORTC Head & Neck Questionnaire (EORTC QLQ-H&N35)]. Results The intervention group had a higher MIO at the two-year follow-up compared to the control group (40.5 mm and 34.3 mm, respectively), which was statistically significant. The intervention group also reported less jaw-related problems according to the GTQ and higher functioning as measured by EORTC QLQ-C30 and QLQ-H&N35 compared to the control group. Conclusion A positive persistent effect of exercise intervention for trismus in HNC patients was found with regard to MIO, trismus-related symptoms and HRQL. Exercise intervention is important in long-term treatment of radiation-induced trismus in HNC patients. The trismus-specific questionnaire, GTQ, is a valuable tool for observing and evaluating trismus over time.

Efficacy of buccal fat pad in the surgical management of oral submucous fibrosis: a prospective study.

PURPOSE: Various surgical treatment modalities have been advocated in the surgical management of oral submucous fibrosis with variable results. This prospective study evaluates the efficacy of buccal fat pad in the surgical treatment of oral submucous fibrosis. PATIENTS AND METHOD: In the present study, 20 patients were treated for oral submucous fibrosis with interincisal mouth opening less than 16 mm. Surgical procedure included fibrotomy, all third molar extractions, and coronoidotomy or coronoidectomy followed by reconstruction of fibrotomy defect with buccal pad of fat. Postoperatively, patients were prescribed nutritional and antioxidant supplements along with vigorous mouth opening exercise for 6 months. Regular follow-up was carried out for 2 years. RESULTS: Excellent increase in the interincisal mouth opening was noticed relieving trismus. Patient's ability of masticate and tolerance to regular food was increased significantly. Buccal fat pad underwent rapid epithelization within a period of 5-7 weeks. CONCLUSION: Buccal fat pad can be used effectively in the surgical management of oral submucous fibrosis with good functional and esthetic outcome, with only drawback of supple lobulated fat, which requires delicate handling and its limitation to reach anteriorly beyond the canine region.

Physical therapy in cancer related vs non-cancer trismus.

OBJECTIVE: Trismus may be caused by several factors including those related with cancer and non-cancer disorders. The purpose of our study was to explore the effectiveness of physical therapy in cancer related vs non-cancer trismus. MATERIAL AND METHODS: Thirty trismus patients who had undergone radiotherapy due to a tumor at the maxillary or nasopharyngeal region (cancer group) and 65 trismus patients with various underlying causes (non-cancer group) were enrolled. Fifteen sessions of physical therapy have been applied to both TMJ regions of the patients. Patients performed active manual stretching and relaxation exercises with the company of a physiotherapist after each physical therapy session. RESULTS: Although maximal mouth opening (changing from 17.7±5.4 to 27.4±6.9 mm in non-cancer group and from 10.5±5.6 to 12.8±6.9 mm in cancer group) and VAS values (changing from 58.4±21.5 to 41.8±22.4 mm in non-cancer group and from 68.3±25.7 to 60.3±25.7 mm in cancer group) showed significant improvements in both groups at the end of the physical therapy program (p=0.00); the difference was significantly higher in the non-cancer group (p=0.00). Post-treatment patient global self-assessment was found to be significantly higher in the non-cancer group when compared with the cancer group (p=0.005). CONCLUSIONS: In summary, combined physical therapy and exercise program appears to be effective in the treatment in both cancer related and non-cancer trismus. But clinical relevance of the results is doubtful and far from satisfying in the patients with cancer related trismus.

Combined Transzygomatic and Pterional Approach for Resection of a Dermoid Cyst of the Foreman Ovale.

Dermoid cysts are rare, benign intracranial lesions commonly located in the posterior fossa. We describe a uniquely located dermoid cyst in the foreman ovale resected via a combined pterional and transzygomatic approach.

[DIAGNOSTICS OF POSITION OF THE MOTOR AND TRIGGER POINTS: OF THE CHEWING MUSCLES FOR ZYGOMATIC COMPLEX FRACTURES].

Existing treatment methods of zygomatic complex fractures, which are complicated by contrac- ture of the masseter as a result of displaced bone fragments, have to be improved. Lack of muscle relaxation leads to the formation of local hypertonicity. In spasmodic muscle fibers varies perfusion and hypoxia occurs, which is accompanied by the release of inflammatory mediators and activation of pain receptors. Over time, areas formed local hypertonicity specific trigger points that contain multiple sensory loci and include one or more sensitive nerve endings. A device for the effective electromyographic study of masseters as a source of their condition and the dynamics of changes in masticatory muscles during patient treatment by improving the fixation system on the face of the patient and the introduction of more perfect spatial coordinate system for mathematical calculations masseter motor position (or triggered) point. Patients were examined before and in the dynamics of treatment according to our methodology, which included proper masseter relaxation, reposition and fixation of bone fragments and further medical therapy.

A rare isolated unilateral myositis ossificans traumatica of the lateral pterygoid muscle: a case report.

INTRODUCTION: Myositis ossificans traumatica is a pathological condition characterized by the extraskeletal formation of bony tissue, induced by violent or repeated trauma. CASE PRESENTATION: A 30-year-old Italian man, after surgical treatment for multiple facial fractures, presented with a progressive limitation of mouth opening. A computed tomography scan showed a significant calcification of the fibers of the left lateral pterygoid muscle. The working diagnosis was myositis ossificans traumatica of the left lateral pterygoid muscle. Surgical excision was suggested but not performed. Our patient underwent physiotherapy treatment resulting not in a complete restoration of mandibular movements but in an acceptable recovery of mouth opening. CONCLUSIONS: Myositis ossificans is a rare complication that can be caused by muscle trauma. Therefore, special attention should be paid to surgical trauma. In the present case, surgical excision was considered, in accordance with the literature, and suggested to our patient, but he declined due to the absence of any pain or any significant limitation to his daily life activities. He therefore underwent physiotherapy treatment, in line with our unit's guidelines, resulting not in a complete restoration of mandibular movements but in an acceptable recovery of mouth opening.

Kinesiologic taping reduces morbidity after oral and maxillofacial surgery: a pooled analysis.

BACKGROUND: Postoperative morbidity is a major disadvantage after oral and maxillofacial (OMF) surgery, often caused by pain, trismus and swelling affecting patients' quality of life. The goal of this study was to examine the effect of kinesiologic taping (KT) on swelling, pain, trismus and patients' satisfaction after OMF surgery. MATERIALS AND METHODS: Performing a pooled analysis of 96 patients that were assigned for maxillofacial treatment (midface fractures n = 30, mandibular fractures n = 26, wisdom tooth removal n = 40) divided into treatment either with or without kinesiologic tape application. Tape was applied directly after surgery and maintained for at least 5 d postoperatively. Facial swelling was quantified at six specific points in time using a five-line measurement. Pain and degree of mouth opening was measured. Patients' objective feeling and satisfaction was queried. RESULTS: Application of KT after OMF surgery has a significant influence on the reduction of swelling decreasing the turgidity for 60% during the first 2 d after surgery. Evaluating all patients swelling was significantly lower in the KT treatment group (T2: 63.5 cm ± 4.3; T3: 62.5 cm ± 4.2; T4: 61.6 cm ± 4.2) than in the no-KT group (T2: 67.6 cm ± 5.0; T3: 67.0 cm ± 5.0; T4: 64.8 cm ± 4.8) at T2 (p < 0.001), T3 (p < 0.001), and T4 (p = 0.001). VAS Pain values were scored significantly lower for the KT group (T1: 2.5 ± 2.0 (p = 0.006); T2: 1.7 ± 2.0 (p < 0.001); T3: 1.5 ± 2.3 (p = 0.004); T4: 0.6 ± 1.1 (p = 0.001) compared to the no-KT group (T1: 3.8 ± 2.5; T2: 3.5 ± 2.7; T3: 2.9 ± 2.2; T4: 1.6 ± 1.7). A statistically significant amelioration in mean mouth opening ability was observed in the KT group (T1-BL: -0.08 cm ± 0.49 (p = 0.025); T2-BL: 0.07 cm ± 0.59 (p = 0.012); T3-BL: 0.20 ± 0.63 (p = 0.013); T4-BL: 0.42 ± 0.59 (p = 0.003)) compared to the no-KT group (T1-BL: -0.47 cm ± 0.86; T2-BL: -0.39 cm ± 0.84; T3-BL: -0.24 ± 0.89; T4-BL: -0.13 ± 1.02). CONCLUSION: KT after OMF surgery is a promising, simple, less traumatic, economical approach free from systemic adverse reaction upgrading patients' quality of life.

Prophylactic training for the prevention of radiotherapy-induced trismus - a randomised study.

BACKGROUND: Radiotherapy-induced trismus (RTIT) is a debilitating condition without any proven effective treatment. This study investigates the effectiveness of prophylactic training to prevent RTIT during and up to 12 months after completed RT in patients with head and neck cancer (HNC), also investigating the incidence of RTIT. METHODS: Sixty-six consecutive patients from two RT clinics in Sweden were randomised into one of two groups: training with TheraBite(®) Jaw Motion Rehabilitation System(™) or a control group. Maximum interincisal openings (MIO) were recorded at baseline and once a week during treatment, three, six and 12 months after completed RT. Training frequency was recorded by patients in a log book. RESULTS: There were no significant differences in MIO between the intervention and control groups at any of the measurement points. Patients in both groups maintained their normal variation in MIO at 12 months after completed RT. A small group of patients in the control group had a 17% mean decrease in MIO by week 6 compared to baseline and improved their MIO by using the training programme. There was a significant mean difference in MIO from baseline to week 6 (3 mm, p = 0.018), and month 6 (2.7 mm, p = 0.040), for patients receiving 3D conformal radiotherapy. There was a significant difference in MIO between patients treated with RT and concurrent chemotherapy compared to patients with RT only at 12 months (p = 0.033). CONCLUSIONS: Patients with HNC undergoing high dose RT do not need to be burdened with an intense prophylactic training programme during RT and up to 12 months after completed RT. MIO measurements during RT and up to 12 months after completed RT are recommended to identify a small risk group who are an exception and may need a training programme.

Spring-bite: a new device for jaw motion rehabilitation. A case report.

The present paper describes the design features, potential indications and a clinical application of a newly designed device for jaw motion rehabilitation, the Spring-Bite. This device is characterized by a first class lever mechanism, which allows performing passive jaw motion rehabilitation at constant load without an active participation by the patient. Spring-Bite was developed for the management of temporomandibular joint (TMJ) hypomobility and its application may be much useful in the post-operatory phases of TMJ or orthognathic surgeries as well as in patients with reduced muscular force.

A systematic review of interventions for eating and drinking problems following treatment for head and neck cancer suggests a need to look beyond swallowing and trismus.

PURPOSE: The incidence of head and neck cancer (HNC) is increasing, and treatment advances have contributed to improvements in survival. However, a growing number of HNC survivors now live with the long-term consequences of cancer treatment, in particular, problems with eating. The combined effects of HNC cancer, intensive chemotherapy, radiotherapy and surgery have a profound impact on functional, psychological, social and physical aspects of eating. Evidence is needed to underpin new rehabilitation approaches to address these complex problems. This review aimed to identify and summarise the evidence for rehabilitation interventions aimed at alleviating eating problems after HNC treatment. METHODS: A systematic review of studies indexed in Medline, CinAHL and PsycINFO using search terms relevant to a wide range of aspects of eating. Publications reporting empirical findings regarding physical, functional and/or psychosocial factors were included. RESULTS: Twenty-seven studies were identified. Fifteen focussed on swallowing exercises, eight on interventions to improve jaw mobility and four on swallowing and jaw exercises. None included interventions to address the complex combination of functional, physical and psychological problems associated with eating in this patient group. CONCLUSIONS: This review highlights that, whilst there is some evidence to support interventions aimed at improving swallowing and jaw mobility following treatment for HNC, studies are limited by their size and scope. Larger, high quality studies, which include patient-reported outcome measures, are required to underpin the development of patient-centred rehabilitation programmes. There is also a particular need to develop and evaluate interventions, which address the psychological and/or social aspects of eating.