Early and long-term effects of physiotherapy for trismus in patients treated for oral and oropharyngeal cancer

ABSTRACT

OBJECTIVE: Study aim was to analyze early and late effects of physical therapy in the mouth opening of patients with trismus after treatment for oral and oropharyngeal cancer. METHODS: This was an ambispective cohort study, including 29 patients with oral and oropharyngeal squamous cell carcinomas treated by surgery and/or adjuvant radiotherapy. Physical therapy including an active range of motion exercises, manual stretching and CRAC (contract-relax, antagonistcontract) technique were applied. Information about tumor, cancer treatment, physical therapy and mouth opening was obtained from the medical or physical therapy records. Assessment of mouth opening was performed at three moments pre-physical therapy, at the end of the last session of treatment (early results) and when patients were invited for a new functional evaluation (long-term results).RESULTS: Mouth opening increased significantly in both early and long-term evaluations (p < 0.001). The initial mouth opening measurements (23.2mm) were significantly smaller than the post-physical therapy (33.9 mm) and long-term measurements (38.1 mm) (p < 0.001). Effect size was 1.0 and 1.4, related to early and late results, respectively. Surgically treated patients seem to have a better long-term response than those treated with adjuvant radiotherapy (p = 0.053). CONCLUSIONS: Mouth opening increased significantly after physical therapy in patients with trismus, and these results were sustained after therapy had been concluded. There seems to be a larger increase in mouth opening in patients treated exclusively by surgery than in patients treated with adjuvant radiotherapy