Page 100 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

Chapter 4
Trismus related outcomes
Trismus related outcomes are presented in Table 3. Median mouth opening deteriorated from 51 (range 36–70) to 45 (range 36–86), but no patients had a mouth opening at or below the cut-off value of 35 mm indicating trismus (30). Also, none of the patients at ten-year plus follow-up perceived their mouth opening as deteriorated, including the four patients who had perceived their mouth opening as deteriorated at six-year follow-up.
Table 3 Trismus related outcomes at six- and ten-year plus follow-up of patients evaluable at ten-year plus follow-up (n = 14).
Number of patients (%)
Six-year follow-up
95% CI
Ten-year plus follow-up
95% CI
Objective outcomes
Mouth opening in mm Median (range) Trismus (MIO < 36 mm)
Perceived deteriorated mouth opening
51 (36–70) 0 (0)
4 (29)
39-65 45 (36–68) 0-22% 0 (0)
12-55% 0 (0)
38-60 0-22%
0-22%
Subjective outcomes
Abbreviations: CI = confidence interval, FOIS = functional oral intake scale, MIO = maximal inter-incisal opening, VAS = visual analog scale.
Voice and speech related outcomes
Voice and speech related outcomes are presented in Table 4. The objective voice quality (based on the AVQI) worsened from 4.7 (range 3.7–6.1) to 3.9 (1.6–8.0). The objective intelligibility (based on the ALF-PPFs) deteriorated slightly between six- and ten-year plus follow-up from 85 (range 67–92) to 75 (69–87). Less patients perceived their voice as different at ten-year plus follow-up (50%) compared to six-year follow-up (57%).
Table 4 Voice and speech related outcomes at six- and ten-year plus follow-up of patients evaluable at ten-year plus follow-up (n = 14).
Number of patients (%)
Six-year follow- up
95% CI
Ten-year plus follow-up
95% CI
Objective outcomes
AVQI (1-8) Median (range) ALF-PPFs (0-100) Median (range)
Perceived different voice
4.7 (3.7–6.1)* 85 (67–92)*
8 (57)
NA* 3.9 (1.6–8.0) NA* 75 (69–87)
33-79% 7 (50)
2.4-5.3 69-86
27-73%
Subjective outcomes
98
VHI and SHI scores of respectively 13 and 12 subjects were available at six-year follow-up.
* Values from earlier publication of Kraaijenga et al. Analyses on speech recordings could not be repeated. Abbreviations: ALF-PPFs = Alignment-free phonological and phonemic features with higher values indicating better intelligibility, AVQI = Acoustic Voice Quality Index with lower values indicating better voice quality, CI = confidence interval, CRT = chemoradiotherapy.