Introduction
Materials and methods
Patient selection
MMO measurements and difficulties opening the mouth
Additional data
Primary analysis
Covariate analysis
Post hoc analysis
Results
Patient characteristics
Total (n = 671) | Surgery only (n = 278) | Radiotherapy only (n = 130) | |
---|---|---|---|
Patient characteristics | n (%) | n (%) | n (%) |
Male | 360 (53.7) | 143 (51.4) | 82 (63.1) |
Age (years), range 11–96 (mean; SD) | 63.4 (13.5) | 62.6 (13.7) | 63.9 (11.3) |
Maximum mouth opening, range 7–73 (mean; SD) | 42.2 (10.6) | 45.0 (8.8) | 41.3 (11.1) |
Dental status | |||
Fully dentulous | 526 (78.4) | 234 (84.2) | 95 (73.1) |
Fully edentulous | 99 (14.8) | 33 (11.9) | 25 (19.2) |
Partially edentulous | 42 (6.3) | 9 (3.2) | 10 (7.7) |
Missing | 4 (0.6) | 2 (0.7) | 0 (0.0) |
Tumour characteristics | |||
Localisation of primary tumour | |||
Tongue | 148 (22.1) | 89 (32.0) | 7 (5.4) |
Floor of mouth | 82 (12.2) | 39 (14.0) | 13 (10.0) |
Maxilla | 34 (5.1) | 17 (6.1) | 7 (5.4) |
Mandible | 49 (7.3) | 23 (8.3) | 1 (0.8) |
Cheek | 19 (2.8) | 8 (2.9) | 1 (0.8) |
Major salivary glands | 70 (10.4) | 30 (10.8) | 5 (3.8) |
Oropharynx | 94 (14.0) | 24 (8.6) | 45 (34.6) |
Hypopharynx and larynx | 32 (4.8) | 0 (0.0) | 24 (18.5) |
Lip | 52 (7.7) | 27 (9.7) | 14 (10.8) |
Unknown primary | 12 (1.8) | 2 (0.7) | 8 (6.2) |
Missing | 79 (11.8) | 19 (6.8) | 5 (3.8) |
T classification | |||
TX | 9 (1.3) | 1 (0.4) | 2 (1.5) |
T1, T2 | 410 (61.1) | 230 (82.7) | 60 (46.2) |
T3, T4 | 143 (21.3) | 18 (6.5) | 56 (43.1) |
Missing | 109 (16.2) | 29 (10.4) | 12 (9.2) |
Treatment characteristics | |||
No treatment | 48 (7.2) | 0 (0.0) | 0 (0.0) |
Surgery | 278 (41.4) | 278 (100.0) | 0 (0.0) |
Radiotherapy | 130 (19.4) | 0 (0.0) | 130 (100.0) |
Combination of surgery and radiotherapy | 215 (32.1) | 0 (0.0) | 0 (0.0) |
MMO measurements versus difficulties opening the mouth
Primary analysis
Cut-off point (mm) | Total study population (n = 671) | Surgery only (n = 278) | Radiotherapy only (n = 130) | ||||||
---|---|---|---|---|---|---|---|---|---|
Sensitivity | Specificity |
J
| Sensitivity | Specificity |
J
| Sensitivity | Specificity |
J
| |
20 | 0.202 | 0.988 | 0.189 | 0.091 | 0.992 | 0.083 | 0.259 | 0.990 | 0.250 |
21 | 0.229 | 0.988 | 0.217 | 0.091 | 0.992 | 0.083 | 0.259 | 0.990 | 0.250 |
22 | 0.266 | 0.986 | 0.252 | 0.091 | 0.992 | 0.083 | 0.370 | 0.990 | 0.361 |
23 | 0.284 | 0.980 | 0.265 | 0.091 | 0.992 | 0.083 | 0.370 | 0.990 | 0.361 |
24 | 0.312 | 0.980 | 0.292 | 0.091 | 0.992 | 0.083 | 0.407 | 0.990 | 0.398 |
25 | 0.330 | 0.980 | 0.311 | 0.091 | 0.992 | 0.083 | 0.444 | 0.990 | 0.435 |
26 | 0.394 | 0.977 | 0.371 | 0.091 | 0.992 | 0.083 | 0.444 | 0.981 | 0.425 |
27 | 0.413 | 0.973 | 0.386 | 0.182 | 0.984 | 0.166 | 0.444 | 0.981 | 0.425 |
28 | 0.468 | 0.959 | 0.427 | 0.182 | 0.977 | 0.158 | 0.481 | 0.971 | 0.452 |
29 | 0.505 | 0.950 | 0.455 | 0.273 | 0.969 | 0.241 | 0.519 | 0.961 | 0.480 |
30 | 0.523 | 0.940 | 0.462 | 0.273 | 0.961 | 0.234 | 0.556 | 0.951 | 0.507 |
31 | 0.624 | 0.916 | 0.540 | 0.409 | 0.961 | 0.370 | 0.630 | 0.893 | 0.523 |
32 | 0.642 | 0.909 | 0.551 | 0.455 | 0.957 | 0.412 | 0.630 | 0.893 | 0.523 |
33 | 0.661 | 0.902 | 0.563 | 0.500 | 0.949 | 0.449 | 0.667 | 0.893 | 0.560a |
34 | 0.688 | 0.874 | 0.562 | 0.500 | 0.918 | 0.418 | 0.704 | 0.845 | 0.548 |
35 | 0.706 | 0.863 | 0.569a | 0.545 | 0.910 | 0.456 | 0.704 | 0.835 | 0.539 |
36 | 0.716 | 0.845 | 0.561 | 0.545 | 0.898 | 0.444 | 0.704 | 0.816 | 0.519 |
37 | 0.761 | 0.786 | 0.548 | 0.636 | 0.859 | 0.496a | 0.704 | 0.767 | 0.471 |
38 | 0.771 | 0.760 | 0.530 | 0.636 | 0.816 | 0.453 | 0.704 | 0.748 | 0.451 |
39 | 0.780 | 0.747 | 0.527 | 0.682 | 0.805 | 0.487 | 0.704 | 0.718 | 0.422 |
40 | 0.807 | 0.698 | 0.505 | 0.727 | 0.750 | 0.477 | 0.704 | 0.689 | 0.393 |
41 | 0.817 | 0.681 | 0.498 | 0.727 | 0.730 | 0.458 | 0.741 | 0.670 | 0.411 |
42 | 0.826 | 0.653 | 0.479 | 0.727 | 0.699 | 0.426 | 0.741 | 0.641 | 0.382 |
43 | 0.862 | 0.544 | 0.407 | 0.773 | 0.594 | 0.366 | 0.778 | 0.544 | 0.321 |
44 | 0.899 | 0.527 | 0.426 | 0.818 | 0.570 | 0.388 | 0.852 | 0.544 | 0.396 |
45 | 0.908 | 0.500 | 0.408 | 0.818 | 0.547 | 0.365 | 0.852 | 0.505 | 0.357 |
Covariate analysis
No difficulties opening the mouth (n = 562) | Difficulties opening the mouth (n = 109) | ||||||
---|---|---|---|---|---|---|---|
n
| % |
n
| % |
χ
2
|
df
|
p
| |
Male sex | 303 | 53.9 | 57 | 52.3 | 0.096 | 1 | 0.756 |
Dental status | 1.646 | 2 | 0.439 | ||||
Dentate | 445 | 79.7 | 81 | 74.3 | |||
Partially edentulous | 34 | 6.1 | 8 | 7.3 | |||
Edentulous | 79 | 14.2 | 20 | 18.3 | |||
Treatment modality | 33.528 | 3 | < 0.001 | ||||
No treatment | 44 | 7.8 | 4 | 3.7 | |||
Surgery only | 256 | 45.6 | 22 | 20.2 | |||
Radiotherapy only | 103 | 18.3 | 27 | 24.8 | |||
Surgery and radiotherapy | 159 | 28.3 | 56 | 51.4 | |||
Mean | SD | Mean | SD | DM | 95% CI |
p
| |
Age | 63.4 | 13.7 | 63.7 | 12.4 | − 0.35 | − 3.1 to 2.4 | 0.804a |
Post hoc analysis
No difficulties opening the mouth (n = 399) | Difficulties opening the mouth (n = 92) | |||||
Median | IQR | Median | IQR | MWU |
p
| |
Time from treatment to measurementa | 28.2 | 8.9; 58.3 | 16.1 | 2.1; 48.0 | 15,174.0 | 0.010 |
Surgery only (n = 220) | Radiotherapy only (n = 80) | |||||
Median | IQR | Median | IQR | MWU |
p
| |
Time from treatment to measurementa | 33.9 | 12.6; 67.4 | 9.6 | 1.5; 31.7 | 4856.5 | < 0.001 |
Surgery only (n = 22) | Radiotherapy only (n = 27) | |||||
Median | IQR | Median | IQR | MWU |
p
| |
Maximal mouth opening measurementb | 34.0 | 29.0; 43.3 | 29.0 | 20.0; 43.0 | 209.5 | 0.078 |