Efeitos dos exercícios de amplitude de movimento mandibular e terapia de deglutição na qualidade de vida dos pacientes em tratamento de câncer de cabeça e pescoço: uma revisão sistemática

Abstract

Head and neck cancer (HNC) treatment can lead to functional sequelae, such as trismus and dysphagia, compromising patients' quality of life (QoL). Although mandibular range-of-motion exercises (MROME) and swallowing therapy are widely used to rehabilitate these complications, their impact on QoL remains uncertain. In this context, this systematic review aimed to evaluate the effects of these interventions on the QoL of patients with trismus and/or dysphagia resulting from HNC treatment. The review was conducted according to Cochrane Handbook recommendations, registered in PROSPERO, and reported in compliance with the PRISMA 2020 statement. Searches were performed in the PubMed, EMBASE, Cochrane Library, LILACS, Scopus, and Web of Science databases and supplemented by a search of grey literature, with no language or publication date restrictions. Risk of bias was assessed using the RoB 2 tool, and the certainty of evidence was evaluated using the GRADE. A total of eight randomized controlled trials (RCTs) comparing MROME and/or swallowing therapy with usual care were included. Overall, the results demonstrated benefits regarding specific functional outcomes, particularly increased mouth opening, improved swallowing, and reduced emotional distress. Conversely, no consistent improvement was observed in global QoL or in the physical, social, and functional well-being domains. Furthermore, high clinical and methodological heterogeneity among the studies, combined with small sample sizes and risk of bias, precluded a meta-analysis and resulted in the evidence for the QoL outcome being classified as very low certainty. In summary, MROME and swallowing therapy show potential for improving functional aspects of rehabilitation for patients with trismus and/or dysphagia following HNC treatment. However, current evidence remains insufficient to demonstrate consistent benefits regarding global QoL. Thus, future studies with greater methodological rigor, standardized protocols, and more representative samples are needed to generate more robust evidence and inform clinical practice.