Abstract

RADIATION INDUCED TRISMUS: A SYSTEMATIC REVIEW

Wafa Hasni*, Rahma Selmi, Dhekra Jlassi, Meriam El Ons Hassouna, Afef Slim, Souha Ben Youssef and Abdelatif Boughzela

ABSTRACT

Introduction: Radiation induced trismus (RIT) called also “restricted mouth opening” is a well-known complication of head and neck (H&N) radiotherapy witch greatly affect functionality and quality of life (QoL) of patients. Its management is often difficult. The purpose of this review was mainly to identify risk factors and management strategies of this complication. Prevalence /incidence, physiopathology and impact on QoL, were also assessed. Materials and methods: Three databases were searched: PubMed, Cochrane library and Google scholar using combined MeSH terms and keywords in boolean equations (time period 2000 to 2018). All English or French articles that meet at least one of our research questions were included. The data were extracted according to a grid of analysis pre-established by the working group. Results: We reviewed 67 articles including 6 systematic reviews. Most of articles assessed management strategies or risk factors. Few studies have addressed the impact on QoL or physiopathology. Conclusion: Prevalence and incidence varied widely among studies. It may be attributed to lack of uniform criteria, visual assessment of RIT and retrospective study design. Newer radiation modalities may decrease the prevalence of RIT compared to conventional radiotherapy. Several risk factors have been identified. The modalities of radiotherapy (type, dose, and field) seem to be the most determining factor. No clear guideline recommendations could be made for the prevention or management of RIT. Although early rehabilitation combining mechanotherapy and specific physiotherapy exercises seems to be the most effective measure.

Keywords: Trismus, Radiotherapy, Head and neck neoplasms, Risk factors, Treatment.