探討張口受限患者的牙關緊閉與生活品質之關係

Assessment of the Relationship Between Trismus and Quality of life in Patients with head and neck Cancer or a Temporomandibular Disorder

目的：探討張口受限患者的牙關緊閉與生活品質之關係，並發展可評估及進一步管理牙關緊閉的量表，期能提供患者更好的照護。
方法：採橫斷式研究，將瑞典文版哥德堡牙關緊閉問卷雙向翻譯及合併，再反向翻譯比對及修正，以專家效度檢測，建立中文版問卷，於110年7月1日至111年2月28日，在北部某醫院口腔外科門診，共收集觀察組，包括頭頸癌（42位）及顳顎關節障礙（17位）；另對照組包括26位無牙關緊閉者。所有個案皆接受中文版哥德堡牙關緊閉問卷、癌症病患生活品質核心量表、頭頸部癌症病患生活品質量表及醫院焦慮與憂鬱量表測量心理面向。
結果：中文版哥德堡牙關緊閉問卷Cronbach’sAlpha值為0.926，專家效度為0.93，統計結果顯示問卷可區分觀察組和對照組患者的牙關緊閉問題。與對照組相比，觀察組中頭頸癌者身體功能、吞嚥困難、言語困難、社交性進食、唾液黏稠等面向分數皆顯著較差（p<0.001）；顳顎關節組於疼痛、吞嚥困難、牙齒問題面向分數皆顯著較差（p<0.001），反之，觀察組在憂鬱部分的分數顯著較高（頭頸癌、顳顎關節、對照組平均值依序為4.3分、3.9分、2.3分）。
結論：在頭頸癌和顳顎關節障礙患者中，牙關緊閉可能與較差的生活品質和較高憂鬱有關，我們應早期管理牙關緊閉問題以提高患者的生活質量。

Purposes This study aimed to analyze the relationship between trismus and quality of life and to develop a scale to identify, evaluate, and thus improve care for patients with trismus.
Methods A cross-sectional design was employed. A Chinese version of the Gothenburg Trismus Questionnaire-2 (GTQ2) was developed using bidirectional translation followed by back-translation, revision, and expert validation. The observation group comprised 59 patients with trismus due to head and neck cancer (n=42) or temporomandibular disorder (n=17); all patients had visited the Oral and Maxillofacial Surgery Outpatient Clinic at a hospital in Northern Taiwan between July 1, 2021, and February 28, 2022. The control group comprised 26 individuals without trismus. The study participants were surveyed using the Chinese GTQ2, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head & Neck, and the Hospital Anxiety and Depression Scale.
Results The Chinese GTQ2 had a Cronbach’s alpha of 0.926 and content validity of 0.93. Statistical analysis showed that it could distinguish between patients with trismus (the observation group) and those without trismus (the control group). Compared with the control group, the observation group scored significantly worse in the following categories: physical function, speech, dysphasia, social eating, and viscous saliva (patients with head and neck cancer); pain and teeth problems (patients with temporomandibular disorders); and dysphagia (both sets of patients) (all p values <0.001). The observation group had significantly higher scores in the depression category (the mean scores for the head and neck cancer patients, temporomandibular disorder patients, and control group were 4.3, 3.9, and 2.3, respectively).
Conclusions In patients with head and neck cancer or temporomandibular disorders, trismus was associated with poor quality of life and relatively severe depression. Early management of trismus is required to improve the quality of life of these patients.