Wu Vincent W C, Lam Ying-Na
Department of Health Technology and Informatics Hong Kong Polytechnic University Hung Hom, Kowloon Hong Kong.
J Med Radiat Sci. 2016 Jun;63(2):124-32. doi: 10.1002/jmrs.145. Epub 2015 Nov 20.
Nasopharyngeal carcinoma (NPC) is endemic in southern China, and its incidence in Hong Kong is relatively high. Radiotherapy is the mainstay treatment for NPC due to its relatively high radiosensitivity and deep-seated anatomical position, which is not readily accessible by surgery. Although the technique of radiotherapy in NPC has been advancing and offers promising treatment outcome, complications around the irradiation areas are inevitable and the quality of life of the post-radiotherapy patients is often compromised. Trismus, which is defined as the restricted mouth opening or jaw movement due to the disorder of temporo-mandibular joint (TMJ), is one of the possible late complications for radiotherapy of NPC and is found in 5-17% of the post-radiotherapy (post-RT) patients. Trismus at early stage may only affect the speech, but in severe cases nutritional intake and oral hygiene condition may deteriorate seriously. This article reviewed the possible causes of radiation-induced TMJ damage, the various assessments including imaging modalities and possible treatments. The conclusion is that the availability of simple, yet effective examinations for trismus is essential for delaying the progression and restoring TMJ functions. Although there is no absolutely effective treatment for trismus, many supportive, restorative and palliative management are possible under different clinical situations.
鼻咽癌（NPC）在中国南方地区呈地方流行态势，在香港其发病率相对较高。由于鼻咽癌具有较高的放射敏感性且解剖位置较深，手术难以触及，因此放射治疗是鼻咽癌的主要治疗手段。尽管鼻咽癌的放射治疗技术不断进步，治疗效果良好，但照射区域周围的并发症仍不可避免，放疗后患者的生活质量常常受到影响。牙关紧闭症是指由于颞下颌关节（TMJ）紊乱导致的张口受限或下颌运动受限，是鼻咽癌放疗可能出现的晚期并发症之一，在5% - 17%的放疗后患者中出现。早期牙关紧闭症可能仅影响言语，但在严重情况下，营养摄入和口腔卫生状况可能会严重恶化。本文综述了放射性颞下颌关节损伤的可能原因、包括影像学检查方法在内的各种评估以及可能的治疗方法。结论是，对于牙关紧闭症，简单而有效的检查对于延缓病情进展和恢复颞下颌关节功能至关重要。尽管对于牙关紧闭症没有绝对有效的治疗方法，但在不同临床情况下可以进行多种支持性、恢复性和姑息性治疗。
