You can expect to see more patients in recovery from oral cancer and the treatment they’re receiving for it. Figures published towards the end of 2020 showed oral cancer rates were not only continuing to rise, they had doubled within a generation.[i]
Early detection and prompt intervention are key to a good prognosis, so education about the risk factors, signs and symptoms is essential. Those at the highest risk include smokers, or those who chew tobacco, especially if they also regularly drink alcohol to excess. An emerging risk factor for oral cancer is the human papillomavirus (HPV), which although related to a far smaller proportion of cases than tobacco and alcohol, has changed the profile of the disease – you don’t have to be a smoker and/or a drinker to be affected by it.[ii] Signs and symptoms to look out for include unexplained and persistent mouth ulcers, unexplained and persistent lumps in the mouth and neck area and unexplained and persistent numbness around the lip and tongue.
Treatment for oral cancer is multi-agency, and the team supporting a patient can involve a range of professionals from clinical oncologists to nurse specialists and speech and language therapists. Not only does treatment aim to optimise a patient’s chance of a full recovery, but also to enable them to enjoy a good quality of life and oral function afterwards. Depending on various factors, it may include surgery and/or radio/chemotherapy, or a combination of these modalities. As with other cancers, the treatment itself can bring unpleasant side effects – in cases of oral cancer, these can impact swallowing, speaking, the ability to clean the mouth comprehensively and even breathing. Hence the need for a multi-skilled support team to give patients all the tailored care they need.
Alongside issues like bleeding and tenderness, another complication of treatment and the cancer itself is trismus, or lockjaw, where the ability to open the mouth is severely restricted and painful. Trismus has a range of other causes, from trauma to infection, and can occur without oral cancer. But if radiation and/or chemotherapy were required, particularly if delivered to the jaw joints and muscles, and/or the patient had surgery, there can be damage and scarring which can lead to trismus.[iii]
Trismus has been defined as “mouth opening less than 35mm”; in severe cases, it is mouth opening less than 20mm.[iv] As well as speaking and communicating, trismus can affect the ability to practise good oral hygiene, as well as eating and drinking, hence their referral to a speech and language therapist. The loss of function that comes with trismus can be distressing, and the patient may want to withdraw.
There are a range of management strategies for trismus; some treatment plans may take a preventive approach, anticipating damage to the jaw joints and muscles post-surgery, for example. One study found that dental health before and at the time of treatment may have a “strong bearing” on being able to predict trismus; in some cases, there may even be a benefit to extracting the posterior teeth.[v] Other risk factors for trismus include the “staging and grading of the malignancy” and method of oral reconstruction. Once therapy for trismus has begun, relief can occur quite soon after, although a long-term approach may be necessary.
In appropriate cases and with the right medical support, management may include pain relief in the form of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin. Or, the patient may be recommended to try a prescribed muscle relaxant, or heat therapy, applying a hot compress regularly to the jaw area.
A dietician may suggest they eat a soft diet until they feel better. For physical therapy and/or in anticipation of trismus, the patient may be encouraged to perform gentle exercises to stretch the jaw area, and continue with these after the “acute” phase has passed, as part of the coordinated care and management plan. There are tools that can be used to help prevent trismus and relieve this uncomfortable and often upsetting condition, such as the OraStretch Press[vi] distributed by Total TMJ, which is a handheld passive motion device that patients will be able to hold comfortably. Easy to use, it can deliver a lifetime of physical therapy for post-treatment trismus also post-surgery rehabilitation. Speech therapists can also use it with patients with indications such as TMJ disfunction and to help them recover after stroke, so they can strengthen this area and retain good function.
Speech and language therapists will frequently be part of the team providing clinical and professional support to oral cancer patients. Of all the complications that can occur to the jaw area and muscles following a diagnosis and treatment, trismus is perhaps less known despite being painful and upsetting. There are a range of treatments available to manage and prevent trismus, included drug-based therapies also physical therapies that can provide effective relief and improvement and avoid the need for another intervention.
For more details about Total TMJ and the products available, please email phil@totaltmj.co.uk or karen@totaltmj.co.uk
[i] UK mouth cancer cases reach record high. Br Dent J 229, 640 (2020). https://doi.org/10.1038/s41415-020-2430-9.
[ii] Br Dent J 229, 640 (2020).
[iii] Santiago-Rosado LM, Lewison CS. Trismus. (Updated 2021 Nov 24). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493203/
[iv] “Open Wide” Can early treatment improve reduced mouth opening? NHS Health Research Authority. Link: https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/open-wide-can-early-treatment-improve-reduced-mouth-opening/ (accessed March 2022)
[v] Scott B, Butterworth C, Lowe D, Rogers SN. Factors associated with restricted mouth opening and its relationship to health-related quality of life in patients attending a Maxillofacial Oncology clinic. Oral Oncol. 2008 May;44 (5):430-8. doi: 10.1016/j.oraloncology.2007.06.015. Epub 2007 Sep 7. PMID: 17826305.
[vi] OraStretch Press System. https://www.craniorehab.com/orastretch [Accessed March 2022]