Department of Otolaryngology, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden.
Med Sci Monit. 2010 Jun;16(6):CR278-82.
The aim was to retrospectively investigate trismus (reduced mandible mobility) development in specified head and neck (H&N) cancer diagnosis according to different radiotherapy dosage regimens.
MATERIAL/METHODS: Sixty-nine out of 246 patients with different H&N cancer diagnoses and available maximum interincisal opening (MIO) measurements before and after treatment were analyzed according to age, gender, radiation dose, tumor site and stage, and Karnofsky Performance Status Scale index. MIO was measured over time (range: 3-48 months), with a cutoff criterion for trismus of 35 mm.
Overall, 42% of the patients had post-treatment MIO <35 mm, and trismus incidence was highest in patients treated for parotid gland tumors followed by those treated for nasopharyngeal cancers. The mean MIO values at baseline were significantly different (p=0.0078) between patients who developed trismus (i.e. MIO <35 mm; mean: 43 mm) and those who did not (mean: 51 mm). The trismus patients also had significantly larger tumors (p=0.0437), poorer physical function before start of treatment (p=0.0344), and had more often received a higher total tumor radiation dose (p=0.0418).
This study reports a high incidence of trismus in H&N cancer patients after treatment. Furthermore, it was found that poor physical function before the start of treatment and high external beam radiation therapy (EBRT) dosages (>50 Gy) were related to significantly more trismus. Future prospective studies are needed to provide a better understanding of different risk factors associated with trismus development, the impact on health-related quality of life, and the effects of early treatment.
本研究旨在回顾性分析不同放疗剂量方案对头颈部（H&N）癌症诊断后牙关紧闭（下颌活动度降低）的发展情况。
材料/方法：根据年龄、性别、辐射剂量、肿瘤部位和分期以及 Karnofsky 表现状态量表指数，对 246 例不同 H&N 癌症诊断且有治疗前后最大开口度（MIO）测量值的患者中的 69 例进行分析。MIO 随时间（范围：3-48 个月）进行测量，以 35mm 作为诊断为牙关紧闭的截断标准。
总体而言，42%的患者治疗后 MIO<35mm，发生牙关紧闭的风险最高的患者是腮腺肿瘤治疗患者，其次是鼻咽癌治疗患者。发生牙关紧闭（即 MIO<35mm；平均值：43mm）和未发生牙关紧闭（平均值：51mm）患者的基线 MIO 值存在显著差异（p=0.0078）。牙关紧闭患者的肿瘤也更大（p=0.0437），治疗前身体功能更差（p=0.0344），且更常接受更高的总肿瘤放射剂量（p=0.0418）。
本研究报告了 H&N 癌症患者治疗后发生牙关紧闭的发生率较高。此外，还发现治疗前身体功能较差和外部束放射治疗（EBRT）剂量较高（>50Gy）与明显更多的牙关紧闭相关。未来的前瞻性研究需要更好地了解与牙关紧闭发展相关的不同风险因素、对健康相关生活质量的影响以及早期治疗的效果。
