Etiopathogenesis of Trismus in Patients With Head and Neck Cancer: An Exploratory Literature Review
Abstract
:Introduction
Materials and Methods
Search Methods
Inclusion and Exclusion Criteria
Results
Discussion
- Trismus due to tumor extension: The primary sites of malignant tumors that induce trismus are commonly the tongue, maxillary sinus, nasopharynx, retromolar trigone, infratemporal fossa, nasal cavity, hypopharynx and cervical esophagus, parotid gland, floor of the mouth, buccal mucosa, larynx, oropharynx, thyroid, palate, ear, and submandibular gland.[15] Among them, the patients with cancer of the tonsils are the one most prone to develop trismus.[16] The proximity of this site to the masticator space and infratemporal fossa could be the reason.
- Primary, benign: Benign neoplasms such as angioma, neurofibroma, neurolemmoma, osteoma, meningioma, and adamantinoma may arise in the infratemporal fossa or invade it from surrounding areas and give rise to trismus.[15] Osteochondromas, myxomas, osteomas, and hemangiomas have also been described as lesions which can cause limitation of mandibular movement.
- Primary, malignant: These are more likely to cause trismus. Carcinomas are tumors of epithelial origin. Epithelial tumors of the buccal mucosa, retromolar area, palate, pharynx, parotid, or maxillary sinus may infiltrate infratemporal fossa. Since carcinoma cells are genetically unstable, they start from an activated phenotype.
Postsurgical Trismus
Postirradiation Trismus
Author | Year | Study Type | Findings |
---|---|---|---|
Chon-Jong Wang et al.[37] | 2005 | Prospective, single-armed measurement | Patients with nasopharyngeal cancer had a mean decrease in initial interincisal distance of 32% at 4 years after radiotherapy. It was rapid at 1 to 9 months after radiation therapy, then became slower and protracted over later years. |
Bhatia et al.[35] | 2009 | Retrospective | The prevalence of trismus increases with increasing doses of RT, and levels in excess of 60 Gy are more likely to cause trismus. An abnormal proliferation of fibroblasts is an important initial event |
Paul Okunieff et al.[38] | 2004 | Non-RCT | FGF2 is chemotactic and mitotic for fibroblasts, whereas TGFβ1 stimulates fibroblast proliferation and premature end differentiation, leading to excessive extracellular matrix glycoprotein production |
Maria GebreMedhin et al.[39] | 2016 | Cohort retrospective | Mean radiation dose to the ipsilateral masseter muscle is an important risk factor for trismus development. |
Hsuing et al.[40] | 2008 | Cohort prospective | Radiation-induced trismus results from postradiotherapy muscle fibrosis and scarring, fibrosis of the ligaments around the TMJ, and scarring of the pterygomandibular raphes. |
Louise Kent et al.[41] | 2008 | Retrospective cohort | Direct cell damage combined with regional loss of vascular perfusion results in bone and soft tissue necrosis and finally leads to fibrosis to the muscles of mastication. |
Marc Goldstein et al.[42] | 1999 | Prospective cohort | As dose to the temporomandibular joint and pterygoid muscles increases, maximal jaw opening decreases linearly. Doses as low as 1493 cGy to the TMJ resulted in functional impairment. |
Lisette van der Molen et al.[45] | 2013 | Prospective longitudinal study | Dose parameters of masseter and pterygoid muscles were significant predictors of trismus at 10 weeks posttreatment. And at 1-year posttreatment therapy, dose parameters of all mastication structures are strong predictors for subjective mouth-opening problems. |
Teguh et al.[43] | 2008 | Retrospective cohort | In radiation-induced fibrosis, there is presence of infiltrating inflammatory cells, atypical fibroblasts, and large amounts of various extracellular matrix components. |
Ichimura and Tanaka[15] | 1993 | Retrospective | Benign neoplasms in the parapharyngeal space and simple compression of the muscles do not induce trismus. |
George P. Katsantonis et al.[44] | 1989 | Retrospective cohort study | Lesions arising in the deep lobe of the parotid will naturally extend into the parapharyngeal space and the infratemporal fossa. Infratemporal fossa invasion is usually associated with trismus and pain along the distribution of V3 and occasionally V2 |
Lisette van der Molen et al.[45] | 2013 | Prospective | Dose parameters of masseter and pterygoid muscles were significant predictors of trismus |
Frank R. Miller et al.[46] | 1996 | Retrospective | Compared with benign parapharyngeal space neoplasms, the malignant tumors were much more likely to be associated with pain, trismus. |
R. Lee et al.[47] | 2012 | Prospective | Current or previous heavy drinkers had a substantially smaller chance of developing trismus. |
The alcohol also acts as a muscle relaxant and counteracts the laying down of collagen. | |||
Joakim Johnson et al.[10] | 2010 | Retrospective | Trismus incidence (≤35 mm) was highest in the patients treated for parotid gland tumors, followed by patients treated for nasopharyngeal cancers and submandibular gland tumors |
Christina Hague et al.[48] | 2018 | Prospective randomized trial | Restricted mouth opening developed when radiation mean doses was >40 Gy to the ipsilateral block. |
Conclusion
Funding
Conflicts of Interest
References
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Raj, R.; Thankappan, K.; Janakiram, C.; Iyer, S.; Mathew, A. Etiopathogenesis of Trismus in Patients With Head and Neck Cancer: An Exploratory Literature Review. Craniomaxillofac. Trauma Reconstr. 2020, 13, 219-225. https://doi.org/10.1177/1943387520917518
Raj R, Thankappan K, Janakiram C, Iyer S, Mathew A. Etiopathogenesis of Trismus in Patients With Head and Neck Cancer: An Exploratory Literature Review. Craniomaxillofacial Trauma & Reconstruction. 2020; 13(3):219-225. https://doi.org/10.1177/1943387520917518
Chicago/Turabian StyleRaj, Radhu, Krishnakumar Thankappan, Chandrasekhar Janakiram, Subramania Iyer, and Anil Mathew. 2020. "Etiopathogenesis of Trismus in Patients With Head and Neck Cancer: An Exploratory Literature Review" Craniomaxillofacial Trauma & Reconstruction 13, no. 3: 219-225. https://doi.org/10.1177/1943387520917518
APA StyleRaj, R., Thankappan, K., Janakiram, C., Iyer, S., & Mathew, A. (2020). Etiopathogenesis of Trismus in Patients With Head and Neck Cancer: An Exploratory Literature Review. Craniomaxillofacial Trauma & Reconstruction, 13(3), 219-225. https://doi.org/10.1177/1943387520917518