[EP-30] Management of Post-Radiotherapy Trismus in Hemi maxillectomy Patients Using Ice Cream Stick and Making a Definitive Aesthetic Obturator with Neutral Zone Impression
[Abstract]
[Introduction]
Trismus is described as a reduction in mouth opening to less than 35 mm which inhibits mastication, phonetic and oral hygiene activities, resulting in a decrease in quality of life. Mouth opening exercises using a Ice Cream Stick and jaw stretching exercises can be treatment options for treating trismus. A metal frame obturator combined with flexible resin can be a treatment option to support masticatory function, phonetics and aesthetics. Obturator stability can also be achieved by the neutral zone impression on the buccal and labial sides of the definitive obturator during the try-in. This can help determine the thickness, contour and support of the cheek, lips and muscles around the maxillary defect.
[Case Summary and Treatment Details]
A 43 year old male patient came to Dental Hospital Universitas Sumatera Utara after completing radiotherapy treatment with limited mouth opening. The patient had a mouth opening of 17 mm. The patient is instructed to place as many wooden sticks as possible between the front teeth. Do mouth opening exercises with a wooden stick 5 times a day for 30 seconds with 5 repetitions. Patients are also taught to do jaw stretching exercises. After finding the desired mouth opening, proceed with making a definitive obturator using a combination of flexible resin and neutral zone impression.
[Progress and Discussion]
The patient's mouth opening was 24 mm after one month of treatment. Next, an obturator is made to close the palatal defect after maxillectomy to support masticatory, phonetic and aesthetic abilities. The use of Flexible Resin material in definitive obturators can improve aesthetics. Neutral zone printing during try-in can provide support for the cheeks, lips and muscles in the maxillary defect.
[References]
1) Lee R, Molassiotis A, Rogers SN, et. al. Protocol for the trismus trial—therabite versus wooden spatula in the amelioration of trismus in patients with head and neck cancer: randomised pilot study. BMJ Open 2018; 8(3)
2) Ezzat YE, Sharka RM, Huzaimi AA, et. al. The role of exercise therapy in managing post-radiotherapy trismus in head and neck cancer. JTUMED 2021; 16(1)
3) Srivastava V, Gupta NK, Tandan A, et. al. The neutral zone: concept and technique. Journal of Orofacial Research 2012; 2(1)
4) Sivam A, Garg A, Sillifant P. Unforeseen Outcomes Post Treatment for Radiation Induced Trismus: A Case Report. Medicines 2022; 9
5) Tannamala PV, Pulagam M, Pottem SR, et. al. Flexible resins in the rehabilitation of maxillectomy patient. Indian Journal of Dental Research 2012; 23(1)
[Introduction]
Trismus is described as a reduction in mouth opening to less than 35 mm which inhibits mastication, phonetic and oral hygiene activities, resulting in a decrease in quality of life. Mouth opening exercises using a Ice Cream Stick and jaw stretching exercises can be treatment options for treating trismus. A metal frame obturator combined with flexible resin can be a treatment option to support masticatory function, phonetics and aesthetics. Obturator stability can also be achieved by the neutral zone impression on the buccal and labial sides of the definitive obturator during the try-in. This can help determine the thickness, contour and support of the cheek, lips and muscles around the maxillary defect.
[Case Summary and Treatment Details]
A 43 year old male patient came to Dental Hospital Universitas Sumatera Utara after completing radiotherapy treatment with limited mouth opening. The patient had a mouth opening of 17 mm. The patient is instructed to place as many wooden sticks as possible between the front teeth. Do mouth opening exercises with a wooden stick 5 times a day for 30 seconds with 5 repetitions. Patients are also taught to do jaw stretching exercises. After finding the desired mouth opening, proceed with making a definitive obturator using a combination of flexible resin and neutral zone impression.
[Progress and Discussion]
The patient's mouth opening was 24 mm after one month of treatment. Next, an obturator is made to close the palatal defect after maxillectomy to support masticatory, phonetic and aesthetic abilities. The use of Flexible Resin material in definitive obturators can improve aesthetics. Neutral zone printing during try-in can provide support for the cheeks, lips and muscles in the maxillary defect.
[References]
1) Lee R, Molassiotis A, Rogers SN, et. al. Protocol for the trismus trial—therabite versus wooden spatula in the amelioration of trismus in patients with head and neck cancer: randomised pilot study. BMJ Open 2018; 8(3)
2) Ezzat YE, Sharka RM, Huzaimi AA, et. al. The role of exercise therapy in managing post-radiotherapy trismus in head and neck cancer. JTUMED 2021; 16(1)
3) Srivastava V, Gupta NK, Tandan A, et. al. The neutral zone: concept and technique. Journal of Orofacial Research 2012; 2(1)
4) Sivam A, Garg A, Sillifant P. Unforeseen Outcomes Post Treatment for Radiation Induced Trismus: A Case Report. Medicines 2022; 9
5) Tannamala PV, Pulagam M, Pottem SR, et. al. Flexible resins in the rehabilitation of maxillectomy patient. Indian Journal of Dental Research 2012; 23(1)