Trismus in Head and Neck Cancer: Causes and Management

  • Adharsh Anand
  • Anil Mathew
  • Deepak Balasubramanian


Reduced mobility of the mandible known as trismus is a phenomenon frequently seen in head and neck (H&N) cancer patients and patients with temporomandibular disorders [1–3]. Although numerous advancements have occurred in head and neck oncology practice during the past few decades, survival has not improved significantly. Currently, there is a need for clinical trials that focus not only on survival but also on the patient’s experience and health-related quality of life.


  1. 1.
    Pauli N, Johnson J, Finizia C, Andréll P. The incidence of trismus and long-term impact on health-related quality of life in patients with head and neck cancer. Acta Oncol. 2013;52:1137–45.CrossRefGoogle Scholar
  2. 2.
    Johnson J, van As-Brooks CJ, Fagerberg-Mohlin B, Finizia C. Trismus in head and neck cancer patients in Sweden: incidence and risk factors. Med Sci Monit. 2010;16:CR278–82.PubMedGoogle Scholar
  3. 3.
    Manfredini D. Current concepts on temporomandibular disorders. London: Quintessence; 2010.Google Scholar
  4. 4.
    Dijkstra P, Huisman P, Roodenburg J. Criteria for trismus in head and neck oncology. Int J Oral Maxillofac Surg. 2006;35:337–42.CrossRefGoogle Scholar
  5. 5.
    Scott B, Butterworth C, Lowe D, Rogers SN. Factors associated with restricted mouth opening and its relationship to health-related quality of life in patients attending a maxillofacial oncology clinic. Oral Oncol. 2008;44:430–8.CrossRefGoogle Scholar
  6. 6.
    D'Cruz AK, Vaish R, Kapre N, et al. Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med. 2015;373(6):521–9.CrossRefGoogle Scholar
  7. 7.
    Bernier J, Cooper JS. Chemoradiation after surgery for high-risk head and neck cancer patients: how strong is the evidence? Oncologist. 2005;10:215–24.CrossRefGoogle Scholar
  8. 8.
    Bensadoun RJ, Riesenbeck D, Lockhart PB, Elting LS, Spijkervet FK, Brennan MT. A systematic review of trismus induced by cancer therapies in head and neck cancer patients. Support Care Cancer. 2010;18:1033–8.CrossRefGoogle Scholar
  9. 9.
    Louise Kent M, Brennan MT, Noll JL, et al. Radiation-induced trismus in head and neck cancer patients. Support Care Cancer. 2008;16:305–9.CrossRefGoogle Scholar
  10. 10.
    Overgaard J, Hansen HS, Specht L, et al. Five compared with six fractions per week of conventional radiotherapy of squamous- cell carcinoma of head and neck: DAHANCA 6 and seven randomised controlled trial. Lancet. 2003;362:933–40.CrossRefGoogle Scholar
  11. 11.
    Teguh DN, Levendag PC, Voet P, et al. Trismus in patients with oropharyngeal cancer: relationship with dose in structures of mastication apparatus. Head Neck. 2008;30:622–30.CrossRefGoogle Scholar
  12. 12.
    Hoffmann TK. Systemic therapy strategies for head-neck carcinomas: current status. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2012;11:Doc03.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Agulnik M. New approaches to EGFR inhibition for locally advanced or metastatic squamous cell carcinoma of the head and neck (SCCHN). Med Oncol. 2012;29:2481–91.CrossRefGoogle Scholar
  14. 14.
    Scott B, D'Souza J, Perinparajah N, Lowe D, Rogers SN. Longitudinal evaluation of restricted mouth opening (trismus) in patients following primary surgery for oral and oropharyngeal squamous cell carcinoma. Br J Oral Maxillofac Surg. 2011;49:106–11.CrossRefGoogle Scholar
  15. 15.
    Buchbinder D, Currivan RB, Kaplan AJ, Urken ML. Mobilization regimens for the prevention of jaw hypomobility in the radiated patient: a comparison of three techniques. J Oral Maxillofac Surg. 1993;51:863–7.CrossRefGoogle Scholar
  16. 16.
    Grandi G, Silva ML, Streit C, Wagner JC. A mobilization regimen to prevent mandibular hypomobility in irradiated patients: an analysis and comparison of two techniques. Med Oral Patol Oral Cir Bucal. 2007;12:E105–9.PubMedGoogle Scholar
  17. 17.
    Cohen EG, Deschler DG, Walsh K, Hayden RE. Early use of a mechanical stretching device to improve mandibular mobility after composite resection: a pilot study. Arch Phys Med Rehabil. 2005;86:1416–9.CrossRefGoogle Scholar
  18. 18.
    Barañano CF, Rosenthal EL, Morgan BA, McColloch NL, Magnuson JS. Dynasplint for the management of trismus after treatment of upper aerodigestive tract cancer: a retrospective study. Ear Nose Throat J. 2011;90(12):584–90.PubMedGoogle Scholar
  19. 19.
    Kamstra JI, Reintsema H, Roodenburg JL, Dijkstra PU. Dynasplint Trismus system exercises for trismus secondary to head and neck cancer: a prospective explorative study. Support Care Cancer. 2016;24(8):3315–23.CrossRefGoogle Scholar
  20. 20.
    Shulman DH, Shipman B, Willis FB. Treating trismus with dynamic splinting: a cohort, case series. Adv Ther. 2008;25:9–16.CrossRefGoogle Scholar
  21. 21.
    Stubblefield MD, Manfield L, Riedel ER. A preliminary report on the efficacy of a dynamic jaw opening device (Dyna splint trismus system) as part of the multimodal treatment of trismus in patients with head and neck cancer. Arch Phys Med Rehabil. 2010;91:1278–82.CrossRefGoogle Scholar
  22. 22.
    Brown KE. Dynamic opening device for mandibular trismus. J Prosthet Dent. 1968;20:438–42.CrossRefGoogle Scholar
  23. 23.
    Dijkstra PU, Kropmans TJ, Tamminga RY. Modified use of a dynamic bite opener--treatment and prevention of trismus in a child with head and neck cancer: a case report. Cranio. 1992;10:327–9.CrossRefGoogle Scholar
  24. 24.
    Brunello DL, Mandikos MN. The use of a dynamic opening device in the treatment of radiation induced trismus. Aust Prosthodont J. 1995;9:45–8.PubMedGoogle Scholar
  25. 25.
    Dijkstra P, Sterken M, Pater R, Spijkervet F, Roodenburg J. Exercise therapy for trismus in head and neck cancer. Oral Oncol. 2007;43:389–94.CrossRefGoogle Scholar
  26. 26.
    Kamstra JI, Roodenburg JL, Beurskens CH, Reintsema H, Dijkstra PU. TheraBite exercises to treat trismus secondary to head and neck cancer. Support Care Cancer. 2013;21:951–7.CrossRefGoogle Scholar
  27. 27.
    Chua DT, Lo C, Yuen J, Foo YC. A pilot study of pentoxifylline in the treatment of radiation-induced trismus. Am J Clin Oncol. 2001;24:366–9.CrossRefGoogle Scholar
  28. 28.
    Hartl DM, Cohen M, Julieron M, Marandas P, Janot F, Bourhis J. Botulinum toxin for radiation-induced facial pain and trismus. Otolaryngol Head Neck Surg. 2008;138:459–63.CrossRefGoogle Scholar
  29. 29.
    King GE, Scheetz J, Jacob RF, Martin JW. Electrotherapy and hyperbaric oxygen promising treatments for postradiation complications. J Prosthet Dent. 1989;62:331–4.CrossRefGoogle Scholar
  30. 30.
    Teguh DN, Levendag PC, Noever I, et al. Early hyperbaric oxygen therapy for reducing radiotherapy side effects: early results of a randomized trial in oropharyngeal and nasopharyngeal cancer. Int J Radiat Oncol Biol Phys. 2009;75:711–6.CrossRefGoogle Scholar
  31. 31.
    Bhrany AD, Izzard M, Wood AJ, Futran ND. Coronoidectomy for the treatment of trismus in head and neck cancer patients. Laryngoscope. 2007;117:1952–6.CrossRefGoogle Scholar
  32. 32.
    Kelsey CR, Jackson L, Langdon S, et al. A polymorphism within the promoter of the TGFb1 gene is associated with radiation sensitivity using an objective radiologic endpoint. Int J Radiat Oncol Biol Phys. 2012;82:247–55.CrossRefGoogle Scholar
  33. 33.
    Ghazali N, Shaw RJ, Rogers SN, Risk JM. Genomic determinants of normal tissue toxicity after radiotherapy for head and neck malignancy: a systematic review. Oral Oncol. 2012;48:1090–100.CrossRefGoogle Scholar
  34. 34.
    Brown JS, Blackburn TK, Woolgar JA, et al. A comparison of outcomes for patients with oral squamous cell carcinoma at intermediate risk of recurrence treated by surgery alone or with postoperative radiotherapy. Oral Oncol. 2007;43:764–73.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Adharsh Anand
    • 1
  • Anil Mathew
    • 2
  • Deepak Balasubramanian
    • 1
  1. 1.Department of Head and Neck Surgery and OncologyAmrita Institute of Medical Sciences, Amrita Vishwa VidyapeethamKochiIndia
  2. 2.Department of ProsthodonticsAmrita School of Dentistry, Amrita Vishwa VidyapeethamKochiIndia

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