Trismus and oral health conditions during diagnosis of malignant oral neoplasms

Martins, Cinthia A.; Goldenberg, Dov C.; Narikawa, Rita; Kowalski, Luiz P.

doi:10.1016/j.bjorl.2019.02.004

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Original articles • Braz. j. otorhinolaryngol. 86 (5) • Sep-Oct 2020 • https://doi.org/10.1016/j.bjorl.2019.02.004 copy

Trismus and oral health conditions during diagnosis of malignant oral neoplasms^☆ ☆ Please cite this article as: Martins CA, Goldenberg DC, Narikawa R, Kowalski LP. Trismus and oral health conditions during diagnosis ofmalignant oral neoplasms. Braz J Otorhinolaryngol. 2020;86:552-7.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Trismus has been considered a late complication of cancer treatment. It can occur prior to treatment, mainly caused by tumor invasion or muscle spasms induced by the presence of the tumor.

Objective:

In this study, we evaluated the incidence of trismus and its effect on oral health in patients with malignant neoplasms of the oral cavity before performing the cancer treatment.

Methods:

This review was carried out via interviews, visual clinical inspection and objective measurement of maximal mouth opening in 35 consecutive patients. Trismus was defined as a maximal mouth opening <35 mm.

Results:

Trismus was observed in 15 patients, with a total incidence of 42%. A high rate of tooth loss was recorded, and trismus association with tooth loss was statistically verified using the Chi-square and Fisher's exact tests, the t-student test and Mann-Whitney non-parametric test. All tests were performed at p < 0.05.

Conclusion:

Edentulous patients are eight times more likely to have trismus compared to patients that are partially and fully dentate. Trismus was demonstrated to be correlated with tooth loss; however other oral health conditions were not shown to be a modifying factor.

KEYWORDS
Trismus; Maximal mouth opening; Oral cancer; Edentulous; Oral health

Patients	ICD-10	Site of neoplasm
1	C02	Floor of the mouth e tongue
2	C060	Floor of the mouth
3	C14	Floor of the mouth, tongue, mandible
4	C03	Alveolar ridge
5	C03	Gun
6	C01	Tongue
7	C14	Mandible
8	C05	Palate
9	C02	Tongue
10	C02	Tongue
11	C02	Tongue
12	C00	Lips
13	C02	Tongue
14	C06	Retromolar trigone
15	C02	Tongue
16	C04	Floor of the mouth
17	C02	Mandible
18	C02	Tongue
19	C02	Tongue
20	C01	Tongue
21	C03	Gum
22	C05	Palate
23	C06	Retromolar trigone
24	C02	Rebordo gengival
25	C02	Tongue
26	C03	Gum
27	C00	Lips
28	C06	Retromolar trigone
29	C05	Palato mole
30	C08	Parotid
31	C06	Retromolar trigone
32	C06	Retromolar trigone
33	C02	Tongue
34	C05	Palate
35	C02	Tongue and floor of the mouth

Location	Trismus		Total	p-value
Location	Yes	No	Total	p-value
2 or more locations	2	2	4
Gum	2	3	5
Tongue	3	8	11
Floor of the mouth	2	1	3
Lip	1	1	2
Retromolar trigone	2	2	4	0.889
Mandible	1	1	2
Alveolar ridge	1	0	1
Parotid	0	1	1
Palate	1	1	2
Total	15	20	35

Location	Palate + Tongue	Others	Total	p-value
n	13	22	35
Mean	41.846	36.023	38.186	<0.001
Median	43	34	38
Standard deviation	9.5729	13.0004	12.0368

Mouth Opening	Patients	Classification
<15 mm	1	Severo
15 < 30 mm	8	Moderate
30 < 35 mm	6	Mild

Mouth opening	Patients with trismus	Patients wthiout trismus	Total	p-value
n	15	20	35
Mínimum	7.5	35	7.5
Mean	27.167	46.45	38.186	<0.001
Median	30	46.5	38
Maxim	34	56	56
Standard deviation	7.5868	7.0073	12.0368

Missing teeth	Patients with trismus	Patients without trismus	Total	p-value
n	15	20	35
Mínimum	0	0	0
Mean	16.6	11.35	13.6	0.170
Median	24	9	9
Maxim	28	25	28
Standard deviation	12.304	8.054	10.273

	Affected teeth in patients with trismus	Affected teeth in patients without trismus
Missing teeth	252	266
Complete edentulous	7	2
Dental cavities	2	3
Endodontics	0	2
Teeth to be extracted	2	6

Edentulous	Trismus		p-value
Edentulous	Yes	No
Yes	7	2	0.022
No	8	18

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail: drdov@me.com (D.C. Goldenberg).

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Trismus and oral health conditions during diagnosis of malignant oral neoplasms☆ ☆ Please cite this article as: Martins CA, Goldenberg DC, Narikawa R, Kowalski LP. Trismus and oral health conditions during diagnosis ofmalignant oral neoplasms. Braz J Otorhinolaryngol. 2020;86:552-7.

Abstract

Introduction:

Objective:

Methods:

Results:

Conclusion:

Trismus and oral health conditions during diagnosis of malignant oral neoplasms^☆ ☆ Please cite this article as: Martins CA, Goldenberg DC, Narikawa R, Kowalski LP. Trismus and oral health conditions during diagnosis ofmalignant oral neoplasms. Braz J Otorhinolaryngol. 2020;86:552-7.