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Dr. D. Y. Patil Vidyapeeth, Pune
(Deemed to be University)
Dr. D. Y. Patil College of Physiotherapy
Sant Tukaram Nagar, Pimpri, Pune-411018

The Transformative Role of Physiotherapy in Oral Cancer Recovery

The Transformative Role of Physiotherapy in Oral Cancer Recovery

Explore transformative role of physiotherapy in oral cancer recovery. Learn about interventions, exercises, and impact on patients' overall well-being.

Ms. Rutuja Wattamwar (BPT Intern)
January, 20 2024
314

Oral cancer is one of the most fatal health problems faced by mankind today and the 6th most common malignancy worldwide. Excessive consumption of tobacco and alcohol, HPV (especially HPV-16), a family history of oral cancer, and genetic predisposition are key risk factors of oral cancer, impacting areas like the tongue, hard and soft palate, extending to the oropharynx, larynx, buccal mucosa, alveola, and retromolar trigone.

Persistent oral lesions such as leukoplakia (white patches) and erythroplakia (red lesions) beyond 2–3 weeks warrant clinical suspicion. Common signs include ulcerated lesions, mobile teeth, gum bleeding, pain/numbness in the face and mouth, poorly fitting dental prostheses, difficulty in swallowing, loss of appetite, loss of weight, etc.

Oral cavity cancers involve a significant structural, functional, and cosmetic burden. Complications commonly seen in oral cancer patients include neck and shoulder dysfunction, trismus, dysphagia, oral mucositis, and head and neck lymphedema.

Physiotherapy plays a significant role in preventing various complications of surgery, chemotherapy, radiotherapy, and chemo-radiation, and restoring the function of the oral cavity, face, chest, shoulder, neck, etc. It can considerably influence speech and swallowing function, increase the range of motion of neck and shoulder joints, reduce pain, enhance mouth opening, and alleviate lymphedema in the postoperative period or after radiation therapy.

In the postoperative period, pain and compensatory postural problems pave the way to shoulder and neck dysfunctions as the spinal accessory nerve is handled and sometimes injured during neck dissection.

The role of physiotherapy in shoulder and neck dysfunction includes active and assisted range of motion exercises with the strengthening of all the muscles of the scapula, which is useful in the prevention of periarthritic shoulder, along with neuromuscular retraining of shoulder girdle muscles and the usage of orthosis.

Secondly, trismus is another sequel to radiotherapy, chemotherapy, or as a post-operative complication characterized by a chronic reduction in mouth opening due to trauma, fibrosis, or spasm of the muscles of mastication.

Physiotherapy for mouth opening is most effective in the recovery phase of 6-8 weeks. Jaw stretching exercises include the opening and closing of the mouth either by using inherent muscle power or with simple devices like mouth props, wooden spatula sticks, or bite blocks.

Manual techniques like myofascial release, TM joint mobilization, and electrotherapeutic modalities like therapeutic ultrasound and Matrix Rhythm Therapy (MRT) to muscles of the cheek, mandible, and lateral part of the neck help in improving physical and functional impairments caused due to trismus.

MRT has proved to be an effective tool for reducing pain by increasing the vascularity of the region and in improving flexibility by directly affecting the stress-strain curve of the muscle resulting in elongation of the muscle. Cheek massage, jaw stretch, facial muscle exercises, tongue movements, sucking, chewing, and intensive mouth opening are a few exercises for the management of trismus.

Dysphagia is one of the most common complications seen in post-operative cases of oral cancer. Physiotherapy plays a crucial role in the treatment of dysphagia. It can be started even before the commencement of cancer treatment to provide the patients with knowledge and ways to practice exercise after treatment.

Various exercises like chin-down posture, strengthening exercises, and bolus manipulation exercises for reduced tongue control are used. Exercises before surgery have shown magical improvements in oral cancer patients.

In near-total glossectomy or total glossectomy, which involves the loss of more than two-thirds of the tongue, exercises such as head-back posture, multiple swallows, and bolus manipulation and swallowing maneuvers like the supraglottic swallow and super-supraglottic swallow maneuver, the effortful swallow maneuver have been shown to be of value in patients with dysphagia.

Oral mucositis is an acute complication after radiotherapy leading to feeding tube dependence, hospitalization, and treatment delays. Transcutaneous electrical nerve stimulation (TENS) is a safe, non-invasive procedure for allaying pain related to mucositis. It provides symptomatic pain relief by blocking the A-beta fibers & stimulating sensory nerves through the gate control theory. Low-level LASER Therapy has been proven safe in reducing pain, severity, and duration of symptoms in patients with cancer therapy-induced oral mucositis.

Cryotherapy, which is administered in the form of ice chips and flavored ice products, has been used to treat oral mucositis and to improve patients’ overall quality of life (QoL) by decreasing its severity and improving nutritional status.

Head and neck lymphedema is another commonly seen complication of oral cancers due to the various surgical and medical treatments the patients undergo. Amongst the various physiotherapeutic interventions, manual lymphatic drainage (MLD), intermittent pneumatic compression, and exercises for the face and neck muscles are meant to be the standard of care in the treatment of lymphedema, which is collectively called complete decongestive therapy (CDT).

Pilates, hydrotherapy, MRT, etc are other newly proven physiotherapeutic treatment options for the management of post-oral cancer head and neck lymphedema. Engaging in physiotherapy certainly brings enhancement in the patient’s psychological, social, emotional, and behavioral well-being, thus improving the overall QoL.

To summarize, the transformative role of physiotherapy in oral cancer reduces various complications related to the disease and its medical and surgical treatments. Various therapeutic interventions and rehabilitation exercises are proven to manage complications in the post-surgery, chemotherapy, radiation therapy period, thus improving physical, psychological, emotional, and functional well-being and overall QoL of the patients.

 

Author

Rutuja Wattamwar (BPT Intern), Dr. Anushka Pillai (Assistant Professor)

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