Definitions of Radiation-induced Trismus in Head and Neck Cancer: Current Concepts and Controversies

Efsun Somay, DDS, PHD; Ahmet Kucuk, MD; Busra Yilmaz, DDS, MSC; Berrin Pehlivan, MD; Ugur Selek, MD; Erkan Topkan, MD

doi:10.36255/radiation-induced-trismus

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Published: Oct 28, 2022

DOI: https://doi.org/10.36255/radiation-induced-trismus

Keywords:

definitions of trismus, head and neck cancer, maximum mouth opening, radiation-induced trismus in head and neck cancer, radiotherapy

Efsun Somay, DDS, PHD

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey

Ahmet Kucuk, MD

Department of Radiation Oncology, Bahcesehir University, Istanbul, Turkey

Busra Yilmaz, DDS, MSC

Department of Radiation Oncology, Mersin City Hospital, Mersin, Turkey

Berrin Pehlivan, MD

Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey

Ugur Selek, MD

Department of Radiation Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA;7Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey

Erkan Topkan, MD

Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Baskent University, Ankara, Turkey

ABSTRACT

Radiation-induced trismus is a devastating side effect of radiotherapy in patients with head and neck cancers. It hampers daily activities like eating, speaking, chewing, swallowing, and oral hygiene routines. Radiation induced trismus also negatively affects social interactions, psychological wellbeing, and lowers the quality of life of patients. The most common method for determining radiation-induced trismus is to measure the ‘maximum mouth opening’. Different cut-off values for maximum mouth opening have been employed in studies that assessed radiation-induced trismus, including 40 mm, 35 mm, 30 mm, and 20 mm. The impact and prevalence of radiation-induced trismus are not fully understood because there is no common and reliable objective measure to determine cut-off values of maximum mouth opening. Additionally, regardless of the pretreatment measures, a standard cut-off is applied to all patients, where a change may be substantial for one patient but not necessarily for another. These discrepancies may cause certain patients' conditions to be overstated or understated, misdirecting their prophylactic or therapeutic interventions. This chapter highlights the current concepts and controversies of the definitions of radiation-induced trismus, and the possible challenges in managing radiation-induced trismus because of the varied definitions.