Strategies for obviation and management of trismus in oral cancer.

PURPOSE OF REVIEW: Trismus (decreased mouth opening) is frequently associated with oral premalignant/malignant lesions, and also occurs in upto 40% of head neck cancer patients post radiation therapy. Trismus is associated with adverse functional and oncologic outcomes through impact on quality of life and posttreatment disease surveillance. Relevant literature is mostly retrospective and single author/institution- a review of the same would aid management of this complex multifactorial disorder.

RECENT FINDINGS: Newer innovations aim at obviation of trismus during treatment planning for head neck cancer, including radiological and serologic prediction, surgical/reconstructive modifications, and tailored radiation therapy with emphasis on sparing excessive treatment to masticatory apparatus.Rehabilitation of manifest treatment-associated trismus, on the other hand, begins with accurate assessment of etiology and extent. Treatments range from exercises and device-based interventions, novel reconstructive methods aimed at ensuring maximal interincisal opening while minimizing donor site morbidity, and ensuring compliance through monitored adherence and self-reporting.

SUMMARY: Trismus prevention and rehabilitation in oral cancer is a multistep sustained process necessitating inputs from several specialties. Personalized treatment and rehabilitation regimens should be incorporated at the outset and continued till at least one year post treatment completion, to ensure optimized outcomes.