University of Pennsylvania, Philadelphia, PA, USA.
Integr Cancer Ther. 2021 Jan-Dec;20:15347354211006474. doi: 10.1177/15347354211006474.
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.
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.
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.
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.
目前对头颈部癌症（HNC）的治疗已经提高了生存率。然而，癌症治疗的后遗症常常导致牙关紧闭，也就是张口受限。本报告的目的是确定针对 HNC 患者的治疗牙关紧闭的干预性研究。
我们于 2020 年 3 月在 PubMed、Embase、 Cumulated Index to Nursing and Allied Health Literature 和 Cochrane Library 中进行了检索，查找了 10 年内针对头颈部癌症的干预性治疗牙关紧闭的随机对照试验（RCT）。干预措施可以包括运动疗法、下颌康复装置、技术设备、药物或按摩疗法。主要结局是张口度的测量。
纳入了 11 项共涉及 685 例 HNC 患者的 RCT。6 项 RCT 评估了下颌运动装置结合运动疗法的效果；与不运动相比，在治疗前、治疗中和治疗后开始运动疗法的下颌运动装置的运动疗法方案并没有显著获益。2 项 RCT 比较了仅包含运动疗法的 2 个干预组，其中 1 项研究评估了每周接受物理治疗联合咀嚼口香糖的益处，另 1 项研究评估了术后即刻（1-2 天）与延迟（7-10 天）开始运动疗法的益处；在这两项研究中，组间均无显著差异。一项仅纳入了有牙关紧闭的患者的 RCT 表明，运动疗法联合低水平激光疗法或低强度超声治疗在张口度测量方面的效果优于单独运动疗法。2 项 RCT 比较了有和没有随访提醒的干预组；两项研究均显示，有随访提醒的组在张口度测量方面有显著改善。
本系统评价未能就 HNC 患者的最佳干预措施达成明确共识。各种运动疗法方案和下颌康复装置似乎具有相当的疗效。然而，集中精力提高对特定干预方案的依从性可能会对头颈部癌症患者的张口度测量产生积极影响。此外，运动疗法联合低水平激光疗法和低强度超声可能对有牙关紧闭的患者有益。
