Authors (including presenting author) :
Ng PCA, Mo JWH, Ngai YYA, Poon WF
Affiliation :
Occupational Therapy Department, Prince of Wales Hospital
Introduction :
Surgery and radiation therapy (RT) are common treatments in head and neck (H&N) cancer survivors. Fibrosis after cancer treatments usually leads to trismus, reduced maximum mouth opening (MMO) and limited H&N movement. Multidisciplinary involvement including Occupational Therapy (OT) is usually indicated only when patients developed trismus with significant swelling and stiffness together with limited H&N movement. In general, clinicians usually treat trismus with wooden spatula and commercial devices which are costly and bulky to commence. Though rehabilitation by OT is not yet a routine practice currently in Prince of Wales Hospital (PWH), a handy and tailor-made splintage with early patient education and rehabilitation by OT should be beneficial to reduce complications and improve quality of life (QoL) for H&N cancer survivors.
Objectives :
To review early rehabilitation by Occupational Therapy with tailor-made oral splintage on improving trismus in head and neck cancer survivors after cancer therapy
Methodology :
H&N cancer survivors reporting trismus (MMO < 35 mm) during oncology follow up were recruited to OT for a rehabilitation program. They were randomly assigned to a control group with wooden spatula or treatment group with newly tailor-made splintage. Self-management program was offered to both groups including use of either wooden spatula or tailor-made oral splintage ; home program for active mobilization on temporomandibular joint (TMJ) and H&N movement with anti-trismus pamphlet provided Maximum mouth opening (MMO), range of movement (ROM) of H&N and pain level were evaluated at the first month and third month after initial review.
Result & Outcome :
From Jan 2020 to Dec 2021, 12 patients with H&N cancer and trismus were recruited in the occupational therapy department. 1) Early rehabilitation 25% of the patients received OT service before RT, while 50% of them during RT in progress, and the remaining 25% of them were treated after RT completion. More obvious improvement in MMO was noted in the patients with OT intervention before and during RT than those treated after RT sessions. 2) Effect on treatment program with use of tailored splintage The MMO increased by an average of 4.0+ 2mm(+36%) in the control group while 6.1+ 5.7mm (+49%) in the treatment group. Clinically significant change was noted in MMO at third month follow up in the treatment group. It was expected that better compliance and treatment effects were resulting due to the newly established program with use of tailor-made oral splintage which is handy and convenient to the survivors. A positive effect was also observed in ROM over neck flexion and neck extension for both groups. Regarding facial and neck pain, a significant improvement was obtained after treatment in the treatment group. Therefore, early rehabilitation involving OT helps H&N cancer survivors in addressing anticipated function loss, habit formation, and the importance of H&N activity can prevent complication development and thus improve function and QoL. Further enhancement on program materials emphasizing compliance of treatment and addressing Qol will be the following focus. Conclusions Early rehabilitation involving Occupational Therapy with the newly tailor-made splintage can be effective in reducing trismus and improving QoL for H&N cancer survivors.
