Background:

Current treatment for head and neck cancers (HNCs) have led to an improved survival. However, the sequelae of cancer treatment often result in trismus, or reduced mouth opening. The purpose of this report is to identify interventional studies for trismus management in HNC patients.

Methods:

A search of PubMed, Embase, Cumulated Index to Nursing and Allied Health Literature, and the Cochrane Library was conducted in March 2020 for randomized controlled trials (RCTs) involving interventions for trismus for head and neck cancer within 10 years. Intervention could involve the use of an exercise regime, jaw rehabilitation device, technological device, medication or massage therapy. The primary outcome was the measurement of mouth opening.

Results:

Eleven RCTs involving a total of 685 patients with HNC were included. Six RCTs evaluated the effectiveness of a jaw mobilization device with exercises; there was no significant benefit of an exercise regime with a jaw mobilization device either initiated before, during or after treatment compared to no exercise. Two RCTs compared 2 intervention groups that involved exercises only, with 1 study assessing the benefit of weekly supervised physical therapy with gum chewing and another evaluating the benefit of immediate (1-2 days) versus delayed (7-10 days) initiation of exercise post-surgery; there was no significant difference between groups in either study. One RCT that recruited only patients with trismus demonstrated that an exercise regime in combination with low-level laser therapy or low-intensity ultrasound had superior results in mouth opening measurements compared to exercise alone. Two RCTs compared intervention groups with and without follow-up reminders; both studies showed a significant improvement in mouth opening measurements in groups with follow-up reminders.

Conclusion:

This systematic review did not convey a clear consensus as to optimal intervention for trismus in HNC patients. A variety of exercise regimens and jaw rehabilitation devices appear to have comparable effectiveness. However, efforts focused on increasing adherence to a particular intervention protocol may positively impact mouth opening measures in head and neck cancer patients. Also, low-level laser therapy and low-intensity ultrasound coupled with exercise may be beneficial for patients with trismus.

中文翻译：

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头颈癌患者牙关紧闭的干预措施：随机对照试验的系统评价

背景：

目前对头颈癌 (HNC) 的治疗提高了生存率。然而，癌症治疗的后遗症通常会导致牙关紧闭或张口减少。本报告的目的是确定 HNC 患者牙关紧闭管理的干预研究。

方法：

2020 年 3 月，对 PubMed、Embase、护理和相关健康文献的累积索引以及 Cochrane 图书馆进行了搜索，以获取涉及 10 年内头颈癌牙关紧闭干预措施的随机对照试验 (RCT)。干预可能涉及使用锻炼方式、下颌康复设备、技术设备、药物或按摩疗法。主要结果是张口的测量。

结果：

包括 11 项 RCT，共涉及 685 名 HNC 患者。六项 RCT 评估了带有锻炼的下颌活动装置的有效性；与不锻炼相比，在治疗之前、期间或之后开始使用下颌活动装置的锻炼方案没有显着益处。两项 RCT 比较了 2 个仅涉及锻炼的干预组，一项研究评估了每周咀嚼口香糖的监督物理治疗的益处，另一项研究评估立即（1-2 天）与延迟（7-10 天）开始锻炼后的益处-外科手术; 在这两项研究中，各组之间没有显着差异。一项仅招募牙关紧闭患者的 RCT 表明，与单独运动相比，运动方案与低强度激光疗法或低强度超声相结合在张口测量方面具有更好的结果。两项 RCT 比较了有和没有跟进提醒的干预组；两项研究都表明，在有后续提醒的组中，张口测量值有显着改善。

结论：

本系统评价并未就 HNC 患者牙关紧闭的最佳干预达成明确共识。各种锻炼方案和下颌康复设备似乎具有相当的效果。然而，专注于提高对特定干预方案的依从性的努力可能会对头颈癌患者的张口措施产生积极影响。此外，低强度激光治疗和低强度超声结合运动可能对牙关紧闭患者有益。