Authors (including presenting author) :
NG APC(1), SHU JYW(1), WONG CYK(1), CHEUNG ASW(1), CHAN RNY(1), POON DWF(1)
Affiliation :
Occupational Therapy Department, Prince of Wales Hospital
Keyword 2: :
Heas and neck cancer
Keyword 3: :
Oral splinting
Keyword 4: :
Anti-trismus
Keyword 5: :
self management
Introduction :
Trismus, defined as restricted mouth opening (< 35mm between upper and lower incisors), is a common complication affecting 30-87% of head and neck cancer patients post-treatment. This functional impairment impacts eating, personal hygiene, communication, and overall quality of life. While early rehabilitation programs demonstrate efficacy in preventing trismus, research on management strategies for established trismus remains limited.
Objectives :
This study evaluated the effectiveness of the Self-management Program incorporating a tailor-made oral splinting device combined with educational materials compared to conventional wooden spatula treatment in managing trismus among head and neck cancer survivors.
Methodology :
A single-blind randomized controlled trial enrolled 40 head and neck cancer patients with trismus referred to Occupational Therapy from the Oncology Clinic in Prince of Wales Hospital. Participants were randomly allocated to either a control group (conventional wooden spatula treatment, n=20) or study group (tailor-made splinting with educational pamphlet and video, n=20). Outcome measures included dental gap, maximal mouth opening (MMO), wooden spatula use, quality of life (QOL), neck range of motion, swelling, stiffness, and compliance over a 4-month period.
Result & Outcome :
Both groups showed significant improvements in dental gap, MMO, and QOL from baseline to 4-month follow-up. The study group demonstrated statistically significant gains in dental gap (22.7 mm to 28.7 mm, p< .001), MMO (28.7° to 33.4°, p< .001), and number of wooden spatulas used (12.8 to 16.3, p< .001) compared with controls. FACT-H&N scores improved significantly, particularly in Trial Outcome Index (mean change 9.5±15.3, p< .001) and total head and neck scores (mean change 8.8±13.5, p< .001). Analysis of cancer stages revealed that stage II & III patients achieved better outcomes than those with stage IV disease, and the study group showed more consistent improvements across 1 month, 2 month, and 4 month assessments in dental gap, neck range of motion, stiffness, swelling, and pain. No clear relationship between splint program compliance and outcome change was observed. Compliance appeared to be inconsistent and tended to decline over time, likely due to common barriers such as fatigue, pain, and radiotherapy-related side effects. Among approximately one quarter of patients who commenced treatment 1 week before or at the start of radiotherapy, improvements in the above outcomes were also noted. Conclusion This study indicates that a tailor-made oral splint, combined with structured education and 4 month follow up, is an effective trismus management strategy. The findings support early rehabilitation, ideally initiated before radiotherapy, and sustained self-management throughout treatment and survivorship Conclusion This study indicates that a tailor-made oral splint, combined with structured education and 4 month follow up, is an effective trismus management strategy. The findings support early rehabilitation, ideally initiated before radiotherapy, and sustained self-management throughout treatment and survivorship
