Prevalence

Patients With Head and Neck Cancer

Patients With TMD and/or Orofacial Pain

Patients With Head and Neck Cancer Head and neck cancer patients who have had radiation therapy, chemotherapy, or surgery are especially susceptible to trismus. A recent study from the University of Rostock shows that 51% of post-treatment head and neck cancer patients have a mouth opening of less than 36 mm. In some cases, such as cancer in the nasopharynx, only 20% of the patients could open more than 36 mm.   The table below shows the prevalence of limited mouth opening (less than 36 mm) based on a study (link to study) of 100 head and neck cancer patients.

Maximal mouth opening in different head and neck cancer forms.

* Maximal incisal opening (Mouth opening)

Courtesy of Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock

To the top

In irradiated patients, restricted jaw movement can cause gradual, unnoticed changes in the muscles and joints. It is not uncommon that radiation therapy leads to formation and shrinkage of connective tissues in the lower jaw and temporomandibular joint (TMJ). The condition can worsen over time, causing pain and further restrict the range of motion in the jaw. Identifying patients with problems and starting them on a passive motion protocol can prevent further deterioration.

In head and neck surgery patients, early rehabilitation to increase or maintain the range of motion in the jaw can help prevent edema, reduce scar formation, and improve the healing process.

• 389 000 head and neck cancer cases worldwide
• High morbidity (undesired complications) from cancer treatment
• 6th most common cancer worldwide, and largely preventable
• 4% of all cancers and 2% of all cancer deaths worldwide
• 95% of patients above 40 years of age at diagnosis
• Mean age is 60 years

1. Xerostomia (dry mouth)
2. Trismus
3. Mucositis
4. Dental caries
5. Osteoradionecrosis
6. Resorption of jaw bones

Patients with head and neck cancer must be meticulous about oral hygiene. The risks for complications increase if oral hygiene is compromised due to trismus!

The temporomandibular joint (TMJ) is used in all jaw movements and is commonly referred to as the jaw joint. Patients with TMJ disorders (TMD) may suffer from mandibular hypomobility (limitation of jaw movement) and orofacial pain in the joint and muscle area.

In the US alone, an estimated 10.8 million Americans suffer from TMD at any given time (Source: The National Institute of Dental and Craniofacial Research of the National Institutes of Health). Since identification of TMD is often based on signs and symptoms rather than on the origin of the disease, many patients find it difficult to receive a correct diagnosis, acknowledgement of their suffering, or compassionate understanding. It often takes a multidisciplinary team - usually including specialists in oral and maxillofacial surgery, general dentistry, speech language pathology, otolaryngology (ear, nose and throat) and neurology -to establish an accurate diagnosis.

Prevalence of mandibular hypomobility and orofacial pain in patients with TMD

• Orofacial Pain: Men 10%, Women 18%
• Pain during lower jaw movement: 7 %
• Occasional pain while chewing: > 30%
• Limited jaw mobility (trismus): 5% to 13%

Trismus (mandibular hypomobility) may be due to joint or muscle (or myofacial) disorders. Joint disorders such as joint ankylosis and synovitis are usually secondary to tumor formation, trauma, arthritis, or infections. Myofacial disorders such as myositis, scleroderma, and acute infections generally have a more favorable prognosis than joint disorders.

To the top

To help reduce the risk for complications from surgery, regardless of how skillfully performed, it is paramount that rehabilitation therapy accompany all surgical procedures, even diagnostic interventions such as arthroscopy.

1. Inflammation (e.g. capsulitis)
2. Edema (e.g. facial and jaw swelling)
3. Formation of adhesions (scarring)
4. Sensory deficit (e.g. numbness)
5. Loss of joint mobility
6. Muscle spasm
7. Continued or increased pain levels
8. Infection
9. Dental malocclusion (improper bite)
10. Foreign body reaction or allergic reaction to implant components (in jaw implants)
11. Wear, displacement, breakage, or loosening of implant components (in jaw implants)

Rehabilitation involving joint mobilization is important to avoid prolonging the course of treatment. Motion is important to nourish cartilage and keep the joint healthy. It is also important to reduce inflammation and edema, reduce scar formation, and aid the healing process. The key is to keep the joint mobile without the risk of unloading it. Hence, passive motion is the preferred therapeutic motion in rehabilitation.

To the top

< Back      Read More >

The TheraBite System