The incidence of trismus and long-term impact on health-related quality of life in patients with head and neck cancer

Figures & data

Table I. Clinical characteristics.

	Study patients	Non-eligible	p-value
	n = 75	n = 34
Age Mean (range)	62 (35–86)	65 (47–86)	ns
Karnofsky index Mean (range)	98 (60–100)	88 (45–100)	< 0.0001
Gender	n (%)	n (%)
Male	45 (60)	20 (59)
Female	30 (40)	14 (41)	ns
Family situation
Married/Cohabitant	46 (64)	15 (44)
Living alone	26 (36)	19 (56)	0.05
Work
In active work	35 (51)	12 (37)
Unemployed	2 (3)	3 (9)
Retired	31 (46)	17 (53)	ns
Smoking
Non-smokers	53 (77)	29 (85)
Smoking	16 (23)	5 (15)	0.0001
Dysfagia
No dysfagia	68 (96)	22 (69)
Only semi solid food	2 (3)	5 (16)
Only pureed food	1 (1)	3 (9)
Only liquid food	0 (0)	2 (6)	0.0003
Comorbidity ACE 27
No comorbidity	34 (48)	6 (18)
Mild comorbidity	20 (28)	15 (44)
Moderate comorbidity	13 (18)	11 (32)
Severe comorbidity	4 (6)	2 (6)	0.03

ACE 27, Adult Comorbidity Evaluation 27.

Figure 1. Study population flow chart with treatment regimens and patients lost to follow-up.

Table II. Tumour location, classification and treatment.

	Study patients n (%)
Tumour location
Salivary gland	10 (13)
Gingiva, buccal	6 (8)
Tonsil	24 (32)
Tongue, floor of mouth	15 (20)
Tumour colli, base of tongue, oropharynx	11 (15)
Sinus, nose	6 (8)
Other (lip, palate, epipharynx)	3 (4)
TNM-Tumour classification
T 0	5 (7)
T 1	13 (17)
T 2	29 (39)
T 3	9 (12)
T 4	18 (24)
Not able to classify	1 (1)
Stage group
I	9 (12)
II	20 (27)
III	16 (21)
IV	29 (39)
Not able to classify	1(1)
Total	75 (100)

Table III. Incidence of trismus in different H&N cancer diagnoses.

	Pre-treatment n = 75	Post-treatment 3 month n = 75	Post-treatment 6 month n = 69	Post-treatment 12 month n = 60
Diagnose	n (%)	n (%)	n (%)	n (%)
Salivary gland	0 (0)	2 (20)	2 (22)	1 (14)
Gingival, bucca	0 (0)	2 (33)	1 (25)	1 (50)
Tonsil	4 (17)	11 (46)	9 (38)	6 (27)
Base of tongue, tumour colli, oropharynx	3 (27)	4 (36)	6 (55)	5 (50)
Tongue, floor of mouth	0 (0)	3 (20)	5 (38)	2 (17)
Sinus, nose	0 (0)	2 (33)	2 (33)	1 (20)
Other (lip, palate, epipharynx)	0 (0)	1 (33)	1 (50)	1 (50)
All diagnoses	7 (9)	25 (33)	26 (38)	17 (28)

Incidence of trismus [maximum interincisal opening (MIO) ≤ 35 mm] during first year of follow-up after end of oncological treatment.

Table IV. GTQ-score, mean value, 95% confidence interval (CI) for H&N cancer patients.

	Pre-treatment	Post-treatment 3 months	Post-treatment 6 months	Post-treatment 12 months
	Mean CI	Mean CI	Mean CI	Mean CI
GTQ time measurement
Jaw-related problems	12.7 7.8–17.6	28.5 *** 22.1–34.8	26.9 *** 20.3–33.5	26.1 *** 19.1–33.0
Eating limitations	22.1 11.7–32.5	33.8 ** 24.2–43.5	29.6 * 22.2–36.9	28.6 20.5–36.7
Muscular tension	8.3 5.1–11.5	13.3 *** 9.4–17.2	15.5 *** 11.2–19.9	15.7 *** 11.5–19.9
Facial pain
Facial pain right now	14.4 8.8–19.9	17.0 11.1–22.8	12.3 7.4–17.2	14.7 9.3–20.0
Facial pain when worst during last month (l m)	27.0 19.9–34.1	31.0 23.6–38.4	25.7 18.3–33.2	25.6 18.4–32.8
Facial pain average value (l m)	22.2 16.3–28.1	27.5 20.6–34.4	22.2 15.5–29.0	21.6 15.8–27.4
Facial pain interfering with social. leisure and family activities (l m)	8.7 4.0–13.4	13.0 7.0–18.9	9.2 4.8–13.7	7.1 3.2–11.1
Facial pain affecting ability to work (l m)	11.6 5.7–17.5	15.6 8.0–23.7	12.7 5.8–19.6	10.3 4.3–16.2
Limitation in opening mouth (LOM)	9.3 4.7–13.8	30.4 *** 23.8–37.0	31.6 *** 24.4–38.7	30.7 *** 23.4–38.0
LOM interfering with social. leisure and family activities (l m)	6.5 2.0–11.1	11.4 * 6.9–15.8	9.7 4.4–14.9	7.0 2.9–11.1
LOM affecting ability to work (l m)	6.6 1.9–11.4	10.3 3.9–16.6	10.5 4.4–16.7	7.9 2.7–13.1

GTQ, Gothenburg Trismus Questionnaire; H&N, head and neck; MIO, maximum interincisal opening.

Domains and single items range 0–100, where 100 indicate maximal amount of symptoms and 0 is equal to no symptoms.

* p < 0.05, **p < 0.01, *** p < 0.001. Statistical significant difference between patients with (MIO ≤ 35 mm) and without (MIO > 35 mm) trismus at the single evaluation time.

Table V. GTQ–score, mean value, 95% confidence interval (CI) for H&N cancer patients with (MIO ≤ 35 mm) and without (> 35 mm) trismus.

	Pre-treatment		Post-treatment 3 months		Post-treatment 6 months		Post-treatment 12 months
	Mean CI		Mean CI		Mean CI		Mean CI
GTQ time of evaluation
MIO (mm)	≤ 35	> 35	≤ 35	> 35	≤ 35	> 35	≤ 35	> 35
N	7	68	25	50	26	43	17	43
Items
Jaw-related problems	35.7 * 9.6–61.8	10.3 5.7–14.9	38.7 * 26.9–50.5	22.5 15.5–29.6	35.3 * 22.2–48.4	21.3 13.8–28.9	36.8 20.0–53.5	21.3 14.0–28.6
Eating limitation	28.1 –12.1–68.3	21.3 9.9–32.7	44.2 * 29.0–59.5	26.8 14.2–39.3	39.8 * 26.0–53.7	22.6 13.9–31.3	42.7 * 24.6–60.8	21.9 13.3–30.5
Muscular tension	11.9 −2.8–26.6	7.9 4.6–11.3	11.5 4.7–18.3	14.4 9.5–19.2	18.3 11.2–25.3	12.6 7.4–17.8	21.9 12.9–30.9	12.9 8.2–17.7
Facial pain (FP)
Facial pain right now	28.6 3.9–53.3	12.8 7.2–18.5	21.4 9.9–33.0	14.4 7.6–21.1	14.2 5.3–23.0	10.0 3.9–16.1	15.6 3.7–27.5	13.4 7.3–19.6
Facial pain when worst last month (l m)	40.5 11.2–69.8	25.5 18.1–32.9	31.0 18.4–43.5	31.0 21.5–40.6	31.7 16.1–47.3	21.0 12.5–29.4	32.3 15.3–49.3	22.4 14.3–30.4
Facial pain average value (l m)	40.5 14.0–67.0	20.3 14.3–26.2	27.0 14.9–39.1	27.8 19.0–36.5	26.7 12.9–40.4	18.6 10.6–26.5	29.2 16.0–42.3	17.9 11.5–24.3
Facial pain interfering with social. leisure and family activities (l m)	8.3 −13.1–29.8	8.7 3.8–13.7	11.3 0.9–21.6	13.9 6.2–21.6	11.3 2.4–20.1	7.9 2.4–13.3	9.4 1.1–17.6	5.8 1.0–10.5
Facial pain affecting ability to work (l m)	0.0 NA	12.7 6.3–19.1	15.0 0.1–29.9	16.0 6.0–25.9	12.5 1.4–23.6	13.6 4.0–23.2	12.5 −2.1–27.1	9.0 2.4–15.5
Limitation in opening mouth (LOM)	37.5 ** −2.3–77.3	6.6 3.1–10.2	40.5 * 27.8–53.2	24.3 17.2–31.3	48.8 *** 36.5–61.0	22.9 15.0–30.8	51.6 *** 36.6–66.5	21.3 14.3–28.2
LOM interfering with social. leisure and family activities (l m)	17.9 * −4.1–39.9	5.2 0.6–9.9	13.1 4.6–21.6	10.3 5.0–15.6	13.8 * 5.7–21.8	7.9 0.4–15.3	12.5 1.6–23.4	3.8 0.3–7.2
LOM affecting ability to work (l m)	14.3 * −3.9–32.5	5.7 0.7–10.8	16.7 3.5–29.8	6.4 −0.3–13.1	12.5 2.8–22.2	10.0 1.4–18.6	15.6 * 0.34–30.9	3.8 −0.1–7.6

GTQ, Gothenburg Trismus Questionnaire; H&N, head and neck; MIO, maximum interincisal opening.

Domains and single items range 0–100 where 100 indicate maximal amount of symptoms and 0 is equal to no symptoms.

* p < 0.05. ** p < 0.01, *** p < 0.001. Statistical significant difference between patients with (MIO ≤ 35 mm) and without (MIO > 35 mm) trismus at the single evaluation time.