Clinical Paper
Head and Neck Oncology
Criteria for trismus in head and neck oncology

https://doi.org/10.1016/j.ijom.2005.08.001Get rights and content

Abstract

The aim of this study was to determine a functional cut-off point for trismus in head and neck oncology. In total, 89 patients (13 dentate, 30 partially dentate and 46 edentulous) treated for cancer of the oral cavity or oropharynx were asked whether they experienced a limited mouth opening. The mandibular function impairment questionnaire (MFIQ) was filled out and mouth opening was measured. The proportion correctly predicted (proportion true positives + proportion true negatives) was calculated. For cut-off points from 25 to 45 mm, differences in MFIQ scores of the restricted and non-restricted groups were analyzed. A receiver operating curve was constructed. The proportion correctly predicted was highest for cut-off point ≤35 mm (0.81), with a sensitivity of 0.71 and a specificity of 0.98. Differences in perceived mandibular function impairments were significant for all cut-off points of 35 mm or less. For the total group, the area under curve was 0.87. For the subgroups of dentate, partially dentate and edentulous patients, no consistent cut-off points could be found on the basis of the proportion correctly predicted and the significance of the difference in MFIQ scores. A mouth opening of ≤35 mm is a functional cut-off point for trismus in head and neck oncology patients.

Section snippets

Patients and methods

Patients 18 years old or above, treated for cancer of the oral cavity or oropharynx at the Department of Oral and Maxillofacial Surgery, Division Oncology, University Medical Center Groningen, were invited to participate in this cross-sectional study. Patients were informed about this study by means of a letter 1 week prior to their regular follow-up appointment. During the appointment the physician informed the patient again and invited the patient to participate. The patients were recruited

Results

Of the 101 patients who were asked to participate, 12 patients did not fulfil the inclusion criteria or refused to participate in the study. Thus, in total 89 patients (88%) participated in the study. Descriptive statistics with respect to tumour type and site and the number of patients who had received radiotherapy are presented in Table 1. Dental status is reported in Table 2. During the assessment, 20 patients in total did not wear their dentures of which 8 did not wear their upper dentures

Discussion

A mouth opening of 35 mm or less should be regarded as trismus in head and neck oncology patients. The arguments for this cut-off point are (1) the maximal proportion of correctly predicted patients of 0.81, (2) the area under curve of 0.87 and (3) the lack of significant difference in mandibular function impairment when a higher cut-off point is applied. For the subgroups, dentate, partially dentate and edentulous, similar analyses were performed but no clear cut-off point per group could be

References (16)

There are more references available in the full text version of this article.

Cited by (241)

View all citing articles on Scopus
View full text