Early use of a mechanical stretching device to improve mandibular mobility after composite resection: A pilot study

Objective: To evaluate the use of a mechanical stretching device, the Therabite, for the early postoperative management of trismus in select patients. Design: Prospective series of consecutive head and neck cancer patients. Setting: Academic, tertiary referral center. Participants: Seven patients with oropharyngeal carcinoma who underwent resection and radial forearm flap reconstruction. Five had midline mandibulotomy procedures for exposure. Six had radiation therapy (2 pre, 4 post). Interventions: Patients were given a Therabite mechanical jaw mobilization device, were instructed in its proper use, and began using it within 6 weeks postoperatively. Main Outcome Measures: Maximal interincisor opening (MIO) was measured at the beginning of use and at the most recent postoperative visit. A 5-question self-assessment telephone survey was administered on study completion. Results: The average MIO was 30mm (range, 21-38mm) at the beginning of the study and 40mm (range, 30-57mm) at the last visit. Average gain in MIO was 10mm (range, 1-21mm). Four of 5 assessable patients had minimal or no limitation on overall quality of life relative to jaw opening. No complications were associated with use of the device. Two patients could not be located for follow-up. Conclusions: The Therabite mechanical stretching device is effective and safe for the management of trismus in a select group of head and neck cancer patients after extensive ablation and complex reconstruction. Specifically, there were no adverse effects in the 5 patients who had undergone midline mandibulotomy. (c) 2005 by American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.