Feasibility of manual therapy in combination with a Dynasplint® for the treatment of trismus in head and neck cancer survivors

• Author / Creator

  Nedeljak, Joni

• Introduction: Trismus, defined as an interincisal opening of less than 35mm, is a significant side effect of treatment seen in survivors of head and neck cancer. As this complication can impact a survivor’s ability to eat, speak, and maintain oral hygiene, effective methods of managing trismus are needed. In the clinical setting, treatment often includes physical therapy and the use of jaw mobilizing devices such as the Dynasplint®. To date, however, there is limited evidence regarding the effectiveness of manual therapy alone or in combination with a jaw mobilizing device to address trismus once it has developed.
  Objectives: The aim of this study was to assess the feasibility of treating survivors of head and neck cancer, presenting with trismus, using a combination treatment comprising manual therapy and home use of a Dynasplint®. Outcomes related to feasibility included feasibility of the intervention process, assessment of resources, personnel and management needs, and safety.
  Methods: An 8-week pre-post study design using single subject analysis was conducted with 10 survivors of head and neck cancer. Participants attended manual therapy sessions twice a week and used the Jaw Dynasplint® System at home twice a day starting from week 3-8 of the study. The primary objective outcome, maximal interincisal opening (MIO), was measured at baseline, before and after each manual therapy session, and at the end of the study. Secondary outcomes to assess quality of life and jaw function were completed at baseline and after the 8-week intervention, and included the Short Form-36 Health Survey (SF-36), a Visual Analogue Scale (VAS), and the Gothenburg Trismus Questionnaire (GTQ).
  
  Results: The findings support feasibility with high recruitment (83%), retention (90%), and adherence rates (97% for manual therapy sessions, 70% for Dynasplint® use). The average MIO increase for the nine participants who completed the study was 2.40mm [median improvement of 2.36mm, a range of -1.99mm to 7.42mm]. No severe adverse events related to the study occurred. One minor adverse event related to use of the Dynasplint® was reported (gum pain; n =1). Two participants developed infections in their mouths (unrelated to the study intervention) that impacted their ability to use the Dynasplint®, and one participant withdrew due to ongoing complications with radiation fibrosis syndrome. No changes were observed for outcomes of quality of life, pain, and trismus related symptoms.
  Conclusion: Given findings supporting feasibility, larger scale studies comparing the effect of manual therapy alone to manual therapy combined with use of a jaw mobilizing device are warranted.

• Subjects / Keywords

  • head and neck cancer
  • Dynasplint
  • trismus

• Graduation date

  Fall 2020

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-zt3m-y454

• License

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