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prevention of shoulder disability after neck dissection is weak, and preventive interventions should only be considered for patients high at risk as well as possessing a clear treatment preference. In this case, too, progressive resistance exercise training seems to be the best option.\u000D5.5.2 Trismus issues resulting from head and neck cancer treatment\u000DMost patients experience a mouth opening smaller than 35mm as a disability, and this is therefore the recommended criterion for trismus (Dijkstra, Huisman et al. 2006, Scott, Butterworth et al. 2008). In 4- 5% of patients with oral cavity/oropharyngeal carcinoma trismus is already present at the time of diagnosis (Balm, Plaat et al. 1997). During and after treatment trismus may arise in 6 to >80% of patients. The wide variation can be explained by differences in tumour location, applied therapy, and total radiation dose and fractionation, as well as differing definitions of trismus (Dijkstra, Kalk et al. 2004, IKNL 2007, Bensadoun, Riesenbeck et al. 2010, Jeremic, Venkatesan et al. 2011, Scott, D\u0027Souza et al. 2011, Steiner, Evans et al. 2015). Trismus is associated with reduced quality of life and worse scores for mood as measured by the HADS (Johnson, Johansson et al. 2015).\u000D5.5.2.1 Detection and evaluation of trismus issues\u000DPatients with a risk of trismus resulting from head and neck cancer treatment are screened prospectively at the AVL by a dentist, dental hygienist, speech therapist and/or physical therapist, depending on their care path. Following a strict protocol, mouth opening is then measured using the TheraBite Range of Motion scale at various moments before, during and after treatment. During screening, only maximum mouth opening is assessed. At the start of treatment for trismus, jaw mobility in all other directions is assessed as well.\u000D5.5.2.2 Physical therapy for reduced mouth opening\u000DStandard adoption of preventive or early jaw motion therapy with or without the help of a mechanical aid such as the TheraBite Jaw Motion Rehabilitation SystemTM (Atos Medical, H\u00F6rby, Sweden) cannot be recommended on the evidence currently available.\u000DA randomised trial (n=66) showed no difference in mouth opening between patients who had practised intensively with the TheraBite, and a control group who had not practised at all. A number of patients in the control group who developed trismus joined the intervention group, upon which mouth opening for them did improve (Loorents, Rosell et al. 2014). It therefore seems to be more effective to monitor patients and start up therapy for those patients whose mouth opening reduces significantly and progressively (see paragraph 5.5.2.1).\u000DOne randomised controlled study investigated the effects of exercise therapy on trismus in 21 patients with a mouth opening of <30mm. All patients had received radiotherapy longer than five years ago (Buchbinder, Currivan et al. 1993). Comparisons were made between active exercise therapy (n=5), stretching of the mouth opening with tongue depressors (n=7) and exercises with the TheraBite (n=9). Exercising with a TheraBite brought about the biggest increase in mouth opening, but the authors do remark that follow-up time within this study was short (10 weeks). The long-term effects of the treatment were not taken into account. Another randomised study (n=50) compared the efficacy of two different mechanical aids for stretching the mouth opening; the TheraBite and the Engstr\u00F6m Jaw Device. There was no difference in efficacy between the two groups, but in both groups mouth opening increased, by 7,2mm (TheraBite \u00AE) and 5,5mm (Enstr\u00F6m). Recovery was slightly quicker in the TheraBite group, and results remained slightly more improved, despite lower compliance in that group (Pauli, Fagerberg-Mohlin et al. 2014). Since this study did not include a control group, no conclusions\u000D123\u000D