Mouth Opening Exercises Research Articles

The impact of different timing of mouth opening exercises on trismus in postoperative radiotherapy patients with oral cancer

ObjectiveTo compare the effects of starting mouth opening exercises at two different times on trismus in postoperative radiotherapy patients with oral cancer. MethodsThrough a prospective randomized controlled trial, purposive sampling was used to select 76 patients undergoing postoperative radiotherapy for oral cancer from March 2023 to January 2024 at the Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Patients were randomly divided into an experimental group (n = 38) and a control group (n = 38) using a random number table at a ratio of 1:1. The experimental group began mouth opening exercises in the second week after surgery (before radiotherapy), while the control group began in the fourth week after surgery (at the start of radiotherapy). The primary outcome measure was maximum interincisal opening (MIO). Secondary outcome measures included pain visual analog scale (VAS) scores and quality of life scores (UW-QOL), assessed at baseline, the second week post-surgery (before radiotherapy), the fourth week post-surgery (at the start of radiotherapy), the ninth week post-surgery (end of radiotherapy), and the twelfth week post-surgery (three weeks after the end of radiotherapy). ResultsA total of 72 patients completed all assessments, with 36 in each group, resulting in an overall sample attrition rate of 5.26 % (less than 15 %). There were no statistically significant differences in general demographic and clinical characteristics between the two groups. Repeated measures ANOVA showed significant differences in MIO, VAS, and UW-QOL scores between groups, over time, and in group-time interactions (P < 0.001). From the fourth week post-surgery (at the start of radiotherapy), the experimental group had significantly higher MIO (P < 0.001), significantly lower VAS scores (P < 0.001), and significantly higher UW-QOL scores (P < 0.001) compared to the control group. These differences persisted at subsequent assessment points. ConclusionInitiating mouth opening exercises in the second week post-surgery (before radiotherapy) can significantly improve mouth opening, reduce pain, and enhance the quality of life in postoperative radiotherapy patients with oral cancer. This provides important evidence for clinical practice, although further research is needed to verify the long-term effects.

Preventing radiation-induced dysphagia and trismus in head and neck cancer-A randomized controlled trial.

Radiation-induced dysphagia and restricted mouth opening are common problems among patients with head and neck cancer. The aim of the present randomized controlled trial was to determine if an exercise protocol could prevent swallowing and mouth opening impairment. Eighty-nine participants were randomly assigned to either an active group performing preventive swallowing and mouth opening exercises (n = 45) or to a control group (n = 44). Outcome measures were collected at baseline before radiotherapy and approximately 1-month post-treatment. Primary endpoints were changes in swallowing function according to the Penetration Aspiration Scale and mouth opening ability measured in millimeters. Intention-to-treat analysis was used. Swallowing function and mouth opening deteriorated in both groups, with no statistically significant positive effect of the protocol detected at follow-up. Among patients who completed >75% of exercises, there was a trend toward better outcomes. Preventive exercises did not improve short-term swallowing function and mouth opening after radiotherapy.

Effect of stainless-steel wire internal fixation on intracapsular condylar fracture.

The aim of the study was to investigate the clinical effect of stainless-steel wire fixation on the early mouth-opening movement of an intracapsular fracture involving the condylar process. In this study, patients who underwent mandibular condylar intracapsular fracture surgery in our hospital from 2012 to 2020 were selected as research subjects. A total of 44 patients received steel wire internal fixation treatment, 32 patients received titanium plate-and-nail rigid internal fixation, and 28 patients underwent conservative non-surgical treatment. For the patients in the stainless-steel wire group, the degree of mouth opening reached normal levels of 3.7 cm approximately 10 days after surgery. The recovery time for the patients in the titanium plate-and-nail rigid internal-fixation group was 21 days, while the patients in the conservative treatment group needed 60 days to recover. The treatment of fixation with a stainless-steel wire for intracapsular condylar fracture reduced the time taken to perform mouth-opening exercises and improved the recovery rate of patients.

Developing and Validating an Intelligent Mouth-Opening Training Device: A New Solution for Restricted Mouth Opening.

Restricted mouth opening (trismus) is one of the most common complications following head and neck cancer treatment. Early initiation of mouth-opening exercises is crucial for preventing or minimizing trismus. Current methods for these exercises predominantly involve finger exercises and traditional mouth-opening training devices. Our research group successfully designed an intelligent mouth-opening training device (IMOTD) that addresses the limitations of traditional home training methods, including the inability to quantify mouth-opening exercises, a lack of guided training resulting in temporomandibular joint injuries, and poor training continuity leading to poor training effect. For this device, an interactive remote guidance mode is introduced to address these concerns. The device was designed with a focus on the safety and effectiveness of medical devices. The accuracy of the training data was verified through piezoelectric sensor calibration. Through mechanical analysis, the stress points of the structure were identified, and finite element analysis of the connecting rod and the occlusal plate connection structure was conducted to ensure the safety of the device. The findings support the effectiveness of the intelligent device in rehabilitation through preclinical experiments when compared with conventional mouth-opening training methods. This intelligent device facilitates the quantification and visualization of mouth-opening training indicators, ensuring both the comfort and safety of the training process. Additionally, it enables remote supervision and guidance for patient training, thereby enhancing patient compliance and ultimately ensuring the effectiveness of mouth-opening exercises.

Comparative assessment of the efficacy of an intralesional injection of placentrex, hyaluronidase and dexamethasone in the management of oral submucous fibrosis: A randomized controlled trial.

The prevalent symptoms of oral submucous fibrosis (OSMF) are a burning sensation and trismus. The aim of the present study was to compare the efficacy of placentrex, hyaluronidase and dexamethasone, and their combination in the treatment of OSMF. For this purpose, 160 patients with OSMF were divided into four groups (each with 40 patients at a 1:1:1:1 allocation ratio). The patients in group 1 (control) received only oral supplements, along with regular mouth-opening exercises; patients in group 2 received an injection of placental extract; patients in group 3 were injected with hyaluronidase and dexamethasone; and patients in group 4 received a combination of injections from groups 2 and 3. The injections were administered once weekly for 12 weeks and patients were followed-up for 12 months. The data of the patients (mouth opening ability and a burning sensation) were analyzed using ANOVA and the Kruskal-Wallis test. The maximum increase in mouth opening (7.30±0.80 mm) was noted in group 4, and the lease increase was observed in the control group (0.37±0.16 mm), from baseline levels to the end of the 12th week. The maximum relapse in mouth opening of 1.62±0.45 mm was noted in group 2, and a minimum relapse of 0.20±0.08 mm was noted in group 4. On the whole, the present study demonstrates that the intralesional injection of a combination of the three drugs (placentrex, hyaluronidase and dexamethasone) in addition to the use of oral supplements and mouth opening exercises has a high level of efficacy in improving trismus and burning sensation in patients with OSMF.

Rehabilitation strategies for trismus post oral cancer treatment: Progress in the study of mouth opening exercises

Oral cancer is a significant public health issue worldwide. Although its treatment methods effectively control tumor growth, they can lead to complications, including Trismus, severely affecting patients' quality of life. The practice standards for mouth opening exercises, a rehabilitative method to prevent and treat Trismus, are not yet clear. Therefore, this article aims to review the research progress of mouth opening exercises in the rehabilitation of Trismus post oral cancer treatment, providing a scientific and effective rehabilitation plan for oral cancer patients to improve their quality of life.

Clinical presentation and management of osteochondroma of the coronoid process (Jacob’s disease)

ABSTRACT Jacob’s disease is characterized by osteochondroma arising from the coronoid process of the mandible. Patients usually present with limitations of mouth opening and cheek prominence. Computed tomography of facial bones with three-dimensional reconstruction was considered the gold standard for diagnosis. Management was principally surgical which involved the removal of the coronoid process either by intraoral or extraoral approach. Postsurgical mouth-opening exercises are considered important for maintaining the obtained results.

Intra-Oral Appliance for Mouth Opening in a patient with OSMF- A Case Report and Literature Review

This paper describes the use of a custom-made intraoral appliance to relieve the trismus of moderate-grade OSMF. A 20-year-old female patient reported a chief complaint of restricted mouth opening due to already diagnosed OSMF. The patient was not satisfied with intralesional therapy and physical mouth-opening exercises. Therefore, a custom-made intraoral mouth- opening appliance was designed and fabricated. The intra-oral appliance have a screw that on activation gradually improves the mouth opening. The device is biocompatible and cost- effective; nonetheless, patient participation is the essential need for good results. The mechanism of other externally and internally activated mouth-opening appliances along with their fabrication is also described.

Innovative Use of Mouth Props/Bite Blocks in Postoperative Mouth Opening Exercises.

Postoperative jaw physiotherapy in the form of mouth opening exercises is an integral part of surgical treatment in oral submucous fibrosis and temporomandibular joint ankylosis. The literature has outlined multiple physical therapy modalities and modifications to aid in assisted mouth-opening exercises. To overcome shortcomings associated with the use of conventional devices, the authors describe an innovative use and modification of a prefabricated soft silicone bite block/mouth prop as an adjunct to the devices to aid in achieving optimal mouth opening.

Physiotherapeutic Approach in Oral Submucous Fibrosis: A Systematic Review.

One of the most poorly recognized and inadequately managed diseases, oral submucous fibrosis progresses over time. Betel nut eating is the foremost cause of oral submucous fibrosis.One such condition is oral submucous fibrosis, which is characterized by severe trismus, disability, and a higher risk of cancer. The mouth opening gradually decreases, which is related to difficulty eating, altered gustatory sensation, and mouth dryness, leading to decreased oral intake. The main and beginning signs include decreased mouth opening, pain, difficulty eating, dry mouth, and blanching of the buccal mucosa.This is treated first with medication, then with exercises for the mouth that a physiotherapist has recommended. However, the function of a physical therapist is not clearly defined. Physiotherapy may be used with other therapies to treat oral submucous fibrosis. Mouth-opening exercises, ultrasound, and other therapeutic interventions are available. This article tries to describe the kind of physical therapy that can be recommended for treating oral submucous fibrosis. It is crucial to understand pain management, physiotherapy management for grade III and IVoral submucous fibrosis various additional exercises, modalities and their ideal dose, and strategy for the long-term effect of the treatments to conduct further research.

Comparison Between Clinical Outcome of Intralesional Human Placental Extract Alone and Topical Application of Placental Extract Gel After Fibrotomy in Oral Submucous Fibrosis.

Oral submucous fibrosis (OSMF) is a premalignant condition prevalent in our country. Juxtaepithelial inflammation with progressive hyalinization of the lamina propria results in stiffness and fibrosis of the oral mucosa, characterised by trismus, ankyloglossia, and a burning sensation. Various methods of treatment have been tried in these cases, which include placental extract injections and the cutting of fibrous bands. In this study, we aim to compare the outcome of intra-lesional placental extract injection with fibrotomy and placental extract gel application in OSMF. This prospective interventional study included 58 patients clinically diagnosed with OSMF grades II and III at a rural tertiary care hospital between January 2021 and August 2022. The patients were randomised into two groups: group I received 1 ml of intra-lesional human placental extract injection in the submucosal plane of the buccal mucosa and retro-molar trigone (RMT) once a week for five consecutive weeks, and group II was subjected to a transverse division of fibrotic bands in the submucosal plane under general anaesthesia. The surgical wound was left open, and swabs soaked in human-purified placental extract gel were placed in the wound for two hours twice daily until the surgical wound was epithelialized and healed. The patients in both groups I and II were advised to do jaw opening exercises, and weekly follow-up was done. Findings with regard to maximum mouth opening, colour of mucosa, and burning sensation in the oral cavity based on a Likert scale were documented. At the end of five months, the pre-treatment and post-treatment results documented were compared. All patients were between 20 and 60 years of age and were addicted to chewing areca nuts with tobacco. Bilateral involvement was present in all patients, with extension into the RMTand soft palate seen in 31%. Improvement in mouth opening was between 4 mm and 6 mm in group II, and relief of burning sensation and mucosal colour was better in group I. Intra-lesional placental extract injections help in the improvement of the mucosa and relief from the burning sensation. Fibrotomy with placental extract gel application is better at relieving trismus in OSMF. Aggressive mouth-opening exercises may improve mouth opening following the above procedures.

Acrylic "lollipop" for jaw rehabilitation after release of joint ankylosis in paediatric patients.

Falls are a leading cause of injuries to the temporomandibular joint (TMJ) in the paediatric age group. In low- and middle-income nations, after injury to a child's chin, a careful clinical examination of the mandible and TMJ is sometimes omitted. Paediatric mandibular condylar fractures tend to shatter the relatively narrow condylar head, leading to ankylosis to the skull base, which leads to debilitating progressive deformity.1 Early surgical release is then the sole modality of treatment and needs to be followed up by several weeks of active mouth-opening exercises to prevent re-ankylosis, which are crucial in the immediate post-operative period. Unfortunately, as patient cooperation is low owing to uncomfortable jaw mobilization, we fabricated a simple acrylic appliance which is easy to use.

EFFICACY OF ISOXSUPRINE AS AN ADJUVANT IN MANAGEMENT OF OSMF: A RANDOMIZED CLINICAL TRIAL

Introduction: Oral submucous brosis is a persistent, insidious mucosal condition that is primarily brought on by areca nut use. It can also be brought on by excessive use of peppers, dietary deciencies, autoimmune, genetics, and environmental factors. The aim of the Aim Of The Study: study was to evaluate the effectiveness of vasodilator isoxsuprine as an adjuvant in the oral submucous brosis management. Study Design: Twenty patients with OSMF were recruited and randomly two groups were divided. Group A: Patients got treated with Isoxsuprine hydrochloride 10 mg thrice daily and antioxidants (Lycopene) twice daily for 3 months. Whereas, in the Group B, antioxidants two times a day for 3 months were given. Both were instructed for mouth opening exercises. All individuals, mouth opening, burning sensation were recorded and reassessment was done at every 15 days during the treatment and after 3 months follow-up and followed by statistical analysis. Visual Analogue Scale Results: (VAS) score for severity of burning sensation was observed in both the groups A &amp;B was statistically signicant whereas interincisal opening was higher in group A patients. Isoxsuprine Hydrochloride can be suggested as an adjunctive t Conclusion: herapy in oral submucous brosis management.

Management of chronic long standing condyle dislocation

Condyle dislocation accounts for 3% of all the dislocations of different joints in the body. They are basically classified based on duration as acute, chronic and recurrent, the most difficult to manage being chronic longstanding. This study of case series was carried out to enunciate and discuss optimal treatment protocols to enhance the postoperative result and functionally rehabilitate the patient. Data were recorded of patients of chronic long standing condyle dislocation (CLSCD) between 2012 to 2019. Predictor variables were drawn from demographics age, gender, aetiology, duration of dislocation status. The outcome variables were surgical success rate and complications. Surgical treatment included endaural pre auricular approach, high condylar shave with eminoplasty, elastic traction for a period of 5-7 days and mouth opening exercises. 15 patients with CLSCD of more than a month duration were identified out of 65 reported with other forms of acute and recurrent dislocation. The 12 (80%) were bilateral and 3 (20%) were unilateral. Three (20%) were of interpersonal violence, 3 (20%) had cerebrovascular accident, 3 (20%) following RTA with other major injuries, and 1 patient (6.6%) very rare unusual history of dislocation during labor pain reporting after six months. All patients had unsuccessful attempted conservative management. Surgical intervention and outcome were excellent. Complications recorded were 3 patients (20%) had transient facial nerve weakness, 2 (13.3%) infection. Conservative manipulation has definitive role in acute and recurrent cases but surgical approach or open procedure in chronic long-standing cases is the choice with duration of condylar dislocation being the decisive factor for difficulty index.

Trismus intra-operative release and expansion (TIRE): A novel operative treatment for trismus.

Trismus is a common symptom for patients with head and neck cancer. This study aimed to evaluate outcomes using the novel Trismus Intra-operative Release and Expansion (TIRE). All patients from 2012 to 2022 with histories of head and neck cancers and trismus treated with TIRE were included. Data examined included measured interincisal distance (IID) before and after treatment, and improvement or worsening of trismus. Thirty-eight patients with trismus were identified, and fourteen underwent TIRE. All had undergone surgery, and 13 had completed radiation therapy prior to TIRE. Mean improvement of IID immediately after TIRE was 18.44 ± 6.02 mm (p < 0.0001). At first follow-up (2.51 ± 3.23 months, n=8), mean improvement from pre-operational measurements was 11.14 ± 9.17 mm (p=0.018). TIRE was initially successful in increasing IID in some patients, but sustained improvements were not consistently seen past 1 year follow-up. TIRE could help resolve trismus enough to proceed with options for trismus therapy using devices and/or mouth opening exercises.

Trismus among Preclinical Students in a Medical College: A Descriptive Cross-sectional Study.

Trismus is a condition of reduced mouth opening due to tonic constrictions of the muscles of mastication. Trismus greatly affects health-related quality of life and thus daily life activities. The aim of this study was to find out the prevalence of trismus among preclinical students in a medical college at a tertiary care teaching hospital. A descriptive cross-sectional study was conducted in a medical college from 10th July 2021 to 10th December 2021 for a period of five months. Ethical clearance was obtained from the Institutional Research Committee (Reference number: 0311202004). A total of 315 preclinical students studying at a medical college were included in the current study. Convenience sampling method was used. Point estimate and 99% Confidence Interval were calculated. Among 315 students, trismus was seen in 14 (4.44%) (1.45-7.43, 95% Confidence Interval) . The clicking sound on the right side of the temporomandibular joint was found to be in 6 (42.86%), on the left side was 5 (35.71%) and that of both sides of the temporomandibular joint was 1 (7.14%) among the 14 students with trismus. The mean maximal interincisal mouth opening was found to be 33.4±0.46 mm in students having trismus. The prevalence of trismus was found to be similar to the other studies performed in similar settings among preclinical students in a medical college. Awareness on mouth opening exercises and timely management can help reduce trismus. prevalence; temporomandibular joint; trismus.

Physiotherapy and occlusal splint treatment in myalgia, cervi-cogenic headache, and arthralgia: a case report

Abstract: The purpose of this study was to describe a rare case of myalgia, cervicogenic headache, and arthralgia in which interaction of physiotherapy, relaxation techniques, cognitive and behavioral counseling, psychosocial support, and occlusal splint treatment resulted in a positive outcome. A 27-year-old woman presented to our clinic with myalgia of the right side of the face, right temporomandibular joint arthralgia, right and left temple pain, jaw elevator muscle pain, and head and neck muscle soreness. The right and left joints' magnetic resonance imaging revealed anterior disc displacement without reduction. The treatment strategy aimed for a non-invasive treatment approach to relieve pain and restore functions. An occlusal appliance with an anterior bite plane was selected, along with counseling, psychosocial support, physiotherapy, posture self-control, massage of the head and neck muscles, mouth opening exercises, and self-massage. A temporomandibular specialist oversaw the splint treatment's progress, a maxillofacial surgeon managed the clinical signs and symptoms of the muscles and joints, and a physiotherapist provided the physiotherapy. Muscle stability in the head and neck has been related to temporomandibular disorders and may have repercussions on craniofacial structure and function. Keywords: physiotherapy; massage; relaxation techniques; oral splint; temporomandibular dis-order

Four-Dimensional Determination of the Patient-Specific Centre of Rotation for Total Temporomandibular Joint Replacements: Following the Groningen Principle.

For patients who suffer from severe dysfunction of the temporomandibular joint (TMJ), a total joint replacement (TJR) in the form of a prosthesis may be indicated. The position of the centre of rotation in TJRs is crucial for good postoperative oral function; however, it is not determined patient-specifically (PS) in any current TMJ-TJR. The aim of this current study was to develop a 4D-workflow to ascertain the PS mean axis of rotation, or fixed hinge, that mimics the patient’s specific physiological mouth opening. Twenty healthy adult patients were asked to volunteer for a 4D-scanning procedure. From these 4D-scanning recordings of mouth opening exercises, patient-specific centres of rotation and axes of rotation were determined using our JawAnalyser tool. The mean CR location was positioned 28 [mm] inferiorly and 5.5 [mm] posteriorly to the centre of condyle (CoC). The 95% confidence interval ranged from 22.9 to 33.7 [mm] inferior and 3.1 to 7.8 [mm] posterior to the CoC. This study succeeded in developing an accurate 4D-workflow to determine a PS mean axis of rotation that mimics the patient’s specific physiological mouth opening. Furthermore, a change in concept is necessary for all commercially available TMJ-TJR prostheses in order to comply with the PS CRs calculated by our study. In the meantime, it seems wise to stick to placing the CR 15 [mm] inferiorly to the CoC, or even beyond, towards 28 [mm] if the patient’s anatomy allows this.

Physical Therapy in Systemic Sclerosis: The Patient Perspective.

To assess the use, satisfaction, needs, and preferences regarding physical therapy (PT) in patients with systemic sclerosis (SSc). A total of 405 SSc patients, treated in the Leiden University Medical Center multidisciplinary care program and fulfilling American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) 2013 SSc criteria, received a questionnaire containing 37 questions on use and satisfaction regarding PT over a 2-year period, and their needs and preferences for future PT. A total of 204 SSc patients (median age 63 years, 81% female) completed the questionnaire. One hundred twenty-eight patients (63%) had used or were using PT in a primary care setting. For 39% of patients not using PT, lack of referral or lack of knowledge was the reason for not using it. The most frequently reported active treatments were muscle-strengthening (n=92 [72%]), range of motion (n=77 [60%]), and aerobic exercises (n=72 [56%]). Specific SSc hand- and mouth-opening exercises were reported by 20 (15%) and 7 (6%) patients, respectively. Manual treatment (massage or passive mobilization) was reported by 83 patients (65%). The mean ± SD satisfaction score (range 0-10) was 8.2 ± 1.6. Regarding patients' needs, 96 patients (47%) of the total group wanted to receive more information concerning PT, and 128 (63%) wanted to continue, start, or restart PT in the near future, with 56 of the 128 patients (44%) favoring individual treatment on a continuous basis. We observed a significant variation in the use and content of PT for SSc patients in a primary care setting. Our results suggest potential underuse of PT care, in particular for hand and oral dysfunction, and underpin the need for initiatives to improve the quality and accessibility of PT care for SSc patients.

Transdermal fentanyl patch versus standard analgesia in postoperative oral submucous fibrosis patients: a triple blinded, randomised control trial

Severe pain experienced by patients with oral submucous fibrosis (OSMF) compromises their physiotherapy and negatively affects the surgical outcome and the patient’s compliance. The main aim of this study was to develop a protocol for pain control in the management of OSMF postoperatively. This was a prospective, parallel with active control, double-arm, triple-blinded, randomised control trial (RCT) with 48 OSMF patients, randomised into two groups - Group A (control, n = 25): received non-opioid analgesics (NSAIDs) and Group B (cases, n = 23): received transdermal fentanyl patches (TFP). Pain and interincisal opening were measured on postoperative days 1, 3, 5, 7, 9, and 15, and on the1st and 3rd postoperative months. Quality of Life (QoL) was assessed preoperatively, on the 15th day postoperatively, and 3rd month postoperatively, and compliance was documented postoperatively on the 9th day. The transdermal fentanyl patch was found to have statistically significantly more effect in controlling severe pain during active mouth opening exercises, and thus significantly increased the patients’ compliance. Although there was increased mouth opening and QoL in the fentanyl group, the differences were statistically insignificant. Our study recommends the use of TFP for better pain control and compliance in postoperative OSMF patients.