Rose Tracey, Leco Pamela, Wilson Jane
The BC Cancer Agency Centre for the Southern Interior, Kelowna, British Columbia, Canada.
The BC Cancer Agency Centre for the Southern Interior, Kelowna, British Columbia, Canada.
J Med Imaging Radiat Sci. 2009 Mar;40(1):32-37. doi: 10.1016/j.jmir.2009.01.002. Epub 2009 Mar 9.
Patients who receive radical radiotherapy to the head and neck may suffer from the late side effect of trismus due to radiation of the jaw. Trismus is progressive once it starts, and can be debilitating due to difficulty eating and inability to perform proper dental hygiene. Although radiotherapy to the temporomandibular joint can restrict mouth opening, the pterygoid muscles-which are responsible for lateral and protrusive motions of the jaw-are more sensitive to radiation. Therefore, damage to these muscles will also limit mouth opening.
A series of simple jaw exercises was designed to help patients maintain jaw mobility and reduce the effect of trismus. In the study, one group of patients used the exercises and the other did not. To assess whether trismus was occurring, dental gap measurements (measurements taken with a ruler from upper incisor to lower incisor, or gum-to-gum) were taken at the start of radiotherapy treatment and again at scheduled follow-up appointments.
There was an overall statistically significant difference between the dental gap measurements of the jaw exercise and the no-jaw exercise group (P = .01, assuming the statistical significance level is .05). Patients who performed the jaw exercises were able to open their mouths wider than the patients who did not do them. Although there appeared to be a difference in decreasing dental gap across time between the two groups in the study, the Wald test did not find this to be statistically significant (P = .1). The use of chemotherapy was not statistically significant; that is, chemotherapy could not be linked with trismus in this study (P = .6171).
The results of this study demonstrate that jaw exercises can be a useful aid to help prevent side effects of trismus due to radiotherapy treatment. Although it is not possible to accurately quantify the effect in this study due to the use of a compensator technique, this intervention was easy to implement and simple for patients to undertake. The jaw exercises continue to be used in the Cancer Centre for the Southern Interior, and a recent revision to the jaw exercises was made with the collaboration of the dental department.
接受头颈部根治性放疗的患者可能会因颌骨放疗而遭受牙关紧闭这一晚期副作用。牙关紧闭一旦开始就会逐渐加重，由于进食困难和无法进行适当的口腔卫生护理，可能会使人衰弱。虽然颞下颌关节放疗会限制张口，但负责颌骨侧向和前伸运动的翼状肌对辐射更敏感。因此，这些肌肉受损也会限制张口。
设计了一系列简单的颌部运动练习，以帮助患者保持颌部活动能力并减轻牙关紧闭的影响。在该研究中，一组患者进行这些练习，另一组则不进行。为评估是否出现牙关紧闭，在放疗开始时以及在预定的随访预约时进行牙间隙测量（用尺子从上门牙到下门牙或牙龈到牙龈进行测量）。
进行颌部运动练习组和未进行颌部运动练习组的牙间隙测量结果总体上存在统计学显著差异（P = 0.01，假设统计显著性水平为0.05）。进行颌部运动练习的患者比未进行练习的患者张口更大。虽然在该研究中两组之间牙间隙随时间减小似乎存在差异，但Wald检验未发现这具有统计学显著性（P = 0.1）。化疗的使用没有统计学显著性；也就是说，在该研究中化疗与牙关紧闭没有关联（P = 0.6171）。
本研究结果表明，颌部运动练习有助于预防放疗导致的牙关紧闭副作用。尽管由于使用了一种补偿技术，在本研究中无法准确量化其效果，但这种干预措施易于实施且患者易于操作。颌部运动练习继续在南部内陆癌症中心使用，并且最近在牙科部门的合作下对颌部运动练习进行了修订。
