Temporomandibular Disorders in Head and Neck Cancer: Risk Factors, Patient Perspectives, and Strategies for Prevention

Abstract

Abstract Treatment of head and neck cancer (HNC) includes radiotherapy (RT), chemotherapy, and surgery and may impair functions resulting in orofacial pain, oral dysfunction, and impaired quality of life. Despite this, few studies describe temporomandibular dysfunction (TMD) and possible prevention in patients treated for HNC. Aim: The overall aim is to improve the understanding of patient experience and to investigate the prevalence, possible risk factors, and outcome of preventive exercise for TMD in patients with HNC. Material and method: In Study I, patients with oropharyngeal tumors were included retrospectively (n = 217). TMD prevalence before oncological treatment and at 6- and 12-months posttreatment were assessed. Study II, a qualitative interview study, included 10 HNC patients post treatment. Data analysis was based on qualitative content analysis. Studies III and IV are based on a prospective and randomized controlled trial with HNC patients (n = 58) randomized into either control or intervention groups before oncologic treatment with a one-year follow-up. Intervention consisted of preventive daily jaw-exercise during radiotherapy. Patients were followed using both objective measurements (Diagnostic Criteria for TMD) and validated questionnaires. Results: Study I: Symptoms of TMD increased 12 months post-RT. Possible factors affecting the increase in TMD symptoms were brachytherapy, mouth opening prior to treatment, self-reported depression, and overall health status. Study II: The results provided a variety of post-treatment consequences, both physical, cognitive, and social. Themes such as emotions and coping strategies both before and after cancer treatment were revealed, indicating a need for a more individually designed approach, support, and rehabilitation. Study III showed that preventive jaw-exercise effectively preserved maximal inter-incisal mouth-opening (MIO) and prevented the development of myalgia both at 6 and 12 months post RT. Study IV confirmed that jaw-exercise helps to protect against decline in MIO and the development of myalgia. A TMD diagnosis at baseline was identified as a risk factor for post-treatment myalgia, whereas no other significant baseline predictors of TMD development were found. Conclusions: TMD-symptoms are common after RT for HNC patients and are perceived to negatively impact daily life. Jaw-exercises before and during RT may help prevent the development of TMD. Keywords: Head and neck cancer, prevention, temporomandibular disorders, predictive Temporomandibular disorders (TMD); head and neck neoplasms; radiotherapy; Symptoms.