Manual therapy has the potential to improve maximum interincisal opening (MIO) among survivors of head and neck cancer (HNC). These findings from a case series were published in JAMA Otolaryngology-Head & Neck Surgery.

Trismus is a common oral morbidity defined as the inability to open the mouth fully. Patients with trismus often report decreased quality of life and increased social isolation. This study sought to evaluate whether MT may be an effective strategy for improving MIO.

Forty-nine survivors of HNC who underwent manual therapy at the University of Texas MD Anderson Cancer Center between 2016 and 2020 were retrospectively reviewed for this study. MIO was evaluated using a Therabite ruler between the maxillary and mandibular central incisors. Severe trismus was defined as <15 mm, moderate as 16-25 mm; mild as 25-35 mm, and >35 mm as a normal opening.


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Participants were 73% men, 51% were aged 65 years and older, 49% had HNC of the oropharynx, the most common tumor stage was stage IV (33%), and 45% had HNC recurrence. In addition to manual therapy, 88% received a home exercise program.

After a single manual therapy session, MIO improved by an average of 4.1 mm and after multiple sessions, by 6.4 mm. Compared with baseline, the number of patients with severe trismus decreased (19 to 8 patients) and the number with normal opening increased (0 to 9 patients).

At the end of the study, 94% had improved MIO compared with baseline. The 3 survivors who did not achieve MIO improvement were found to have underlying recurrent disease.

Manual therapy was well tolerated, with 6.1% reporting soreness.

This study may have been limited by not addressing the various etiologies of trismus.

These data indicated that manual therapy increased the oral opening among survivors of HCN with trismus and may be an effective approach to improving MIO.

Disclosure: Multiple authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference McMillan H, Barbon CEA, Cardoso R, et al. Manual therapy for patients with radiation-associated trismus after head and neck cancer. JAMA Otolaryngol Head Neck Surg. Published online March 17, 2022. doi:10.1001/jamaoto.2022.0082