Physiotherapy in radiation induced trismus (Tight Jaw)

RADIATION INDUCES TRISMUS (RIT) or TIGHT JAW is a common and devastating complication in head and neck cancer patients after radiation treatment. RIT is often attributed to fibrosis (hardening of soft tissue), scar tissue formation, nerve damage, muscle atrophy (decrease in muscle mass), or a combination there of, restricting the muscles of chewing (mastication). This hampers eating, chewing, speaking, swallowing activities in addition to oral hygiene. All the problems begin with inability to open the mouth due to tightness of muscles around the jaw or the tempero -mandibular joint (TMJ joint). The normal mouth opening is about 3 fingers placed between one’s upper and lower teeth in the middle of the mouth. If the mouth opening is less than this in oral cancer patient due to radiation treatment, the patient is said to be suffering from radiation induced Trismus.

Mouth opening Exercises using a Therabite exerciser or jaw exerciser from the 1st day of radiation therapy will help the patient in maintaining the mouth opening preventing early onset of RIT. In absence of Therabite exerciser, patient may use simple ice-cream sticks stacked together and use the same to aid mouth opening.

Manual therapy viz soft tissue techniques like myo-fascial release around the TMJ and the neck muscles will help to loosen the tightened tissue and muscles thereby easing the jaw movements along with neck movements. TMJ mobilization techniques may be administered by a trained physiotherapist after a detailed musculo-skeletal evaluation.

Usage of dry cupping techniques using therapeutic silicon cups (available in various sizes) given by an expert physiotherapist may help the patient to relieve him/her of pain, relieve muscle spasm around the affected jaw and neck,hence aid in relaxation of the affected neck and jaw area.

MATRIX RHYTHM therapy, an advanced therapy has proved to be boon for this condition to release the tightened soft tissue and alleviate pain. Cold LASER (therapeutic low level LASER) is also commonly used to decrease pain and improve blood circulation in the affected area.

All the above mentioned treatments should be administered or supervised by a trained physiotherapist after a detailed evaluation.

Lets aim to prevent a tight jaw by an early referral and an early physiotherapy intervention than worsening the condition by delaying!!

Please visit us at our physiotherapy OPD to have a better healing experience!!

Remember:

“PREVENTION IS ALWAYS BETTER THAN CURE”

Renu B Pattanshetty MPT, Ph.D
Consultant & HOD, Dept. of Oncology Physiotherapy,
Prof & Head, Dept. of Oncology Physiotherapy,
KAHER Institute of Physiotherapy, Belgaum-10 (Karnataka)