Evidence-based practical recommendations for prevention and management of radiation-induced trismus

Abstract

Head and neck cancer (HNC) patients undergoing radiation therapy (RT) commonly experience radiation-induced trismus (RIT), a significant complication that profoundly impacts their quality of life and functional outcomes. Hence, a comprehensive understanding and management of this condition are imperative for radiation oncologists. RIT, characterized by a limited ability to open the mouth, can severely impact essential functions such as speaking, eating, and maintaining oral hygiene. These malfunctions can lead to nutritional deficiencies, weight loss, and an increased risk of oral infections. The pathophysiology involves radiation-induced fibrosis and damage to the masticatory muscles and temporomandibular joint, often exacerbated by concurrent chemotherapy. Identifying at-risk patients and implementing preventive measures against RIT is crucial. These measures may include using advanced radiation techniques such as intensity-modulated RT or proton therapy and early physical therapy. Additionally, personalized treatment planning and multidisciplinary care involving radiation and medical oncologists, dental specialists, and physical therapists can help reduce the onset and severity of RIT. Given the significant impact of RIT on the functionality and quality of life of patients with HNC and the relatively low level of interest in oncological communities, the purpose of this review is to provide an evidence-based summary of effective preventive and management strategies for RIT in HNC patients, which hopefully will serve as a valuable guide for physicians in related disciplines.