Physiotherapy in the prevention and management of radiotherapy-induced trismus: a critical review

Abstract

Aims: The aim of this study is to review current evidence on the use of physiotherapy in the prevention and treatment of Radiotherapy-induced trismus in Head and Neck cancer patients (HNC) and report on its efficacy in such condition. Methods: We searched the digital databases of Medline, Embase, Cochrane Library and PubMed for articles published in the period from January 1980 to July 2015 that were related to the topic. The key word used were trismus, radiotherapy induced trismus, radiotherapy induced trismus, head and neck cancer and physiotherapy in titles, abstract and Mesh terms. Additional articles identified by tracing any literature containing preventive methods or managements for trismus in patients of head and neck cancer. Results: 11 articles related to the use of physiotherapy as a management and/or preventive tool for RT-induced trismus were identified of which 3 were randomized controlled trials, 2 were controlled trails, 5 were cohort studies and 1 were prospective case series. Modalities of physiotherapy used in these studies included unassisted exercises, tongue blade assisted exercises, Therabite® Jaw Motion Rehabilitation System, Dynasplint Trismus System, Engström jaw mobilizing device. Current evidence suggests that passive jaw mobilization devices can be beneficial in individuals with RT-induced trismus, whereas unassisted exercises and active range motion techniques seems to provide less clear benefits. Conclusion: This review demonstrate the various techniques of physiotherapy in prevention and management of radiotherapy induced trismus and its efficacy. Physiotherapy is a valid non￾invasive method to manage radiotherapy induced trismus that need more investigation to maximise its benefits. Passive jaw mobilization devices and structured physiotherapy protocols coupled with positive motivation are effective in increasing mouth opening in HNC treated or planned to be treated with radiotherapy.