Fibrosis, Contractures, and Trismus: Delayed Complications of Treatment of Head and Neck Cancer

Trismus is a debilitating secondary effect of head and neck cancer treatment, characterized by limited mouth opening and range of jaw excursions. It is a long-term complication that is particularly prevalent among patients undergoing radiotherapy for head and neck cancers. The review aims to provide an overview of trismus and its pathobiology in the context of head and neck cancer therapy and discuss preventive and therapeutic measures for effective management and rehabilitation.

A literature review was conducted across PubMed, UpToDate, Cochrane Reviews, and Embase databases, and current evidence was compiled on trismus in head and neck cancer patients.

Trismus can severely impair physiological functions of mastication, swallowing, and speech, and difficulties in swallowing increase the risk of aspiration pneumonitis. Trismus complicates oral hygiene, contributing to the development and delayed recognition of oral diseases and infections. Beyond the physical limitations, trismus has a profound negative impact on the psychosocial well-being of the patient.

Given the rise in HPV-related head and neck cancer and the sensitivity of HPV tumors to radiotherapy, the prevalence of trismus among survivors is expected to increase. As the burden of trismus is life-long, a multidisciplinary approach is critical to improving the quality of life outcomes.