The indirect effect of temporomandibular kinesiophobia on the association between limited mouth opening symptoms and maximum mouth opening in postoperative oral cancer patients: a mediation analysis.

Man Yao, Huang Linfang, Xin Cai, Hengxu Wang, Yangmei Liu, Min Lin, Limin Qing

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Article in Clinical oral investigations, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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7 authors.

Man YaoHead and Neck Surgery Department, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha, China.

Huang LinfangSchool of Nursing, Hunan Normal University, Changsha, 410000, China.

Xin CaiHead and Neck Surgery Department, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha, China. caixin@hnca.org.cn.

Hengxu WangChangsha Medical University, Changsha, China. 1543980936@qq.com.

Yangmei LiuNursing Department of the Second People's Hospital of Hunan Province, Changsha, China.

Min LinChangsha Medical University, Changsha, China.

Limin QingHead and Neck Surgery Department, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha, China.

Funding

Hunan Provincial Natural Science Foudation of China 2025JJ80855Hunan Provincial Natural Science Foudation of China 2026JJ82066

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Abstract

backgroundLimited mouth opening is a prevalent complication among oral cancer patients, greatly impairing their physical and mental health as well as overall quality of life. Although the physiological mechanisms of mouth-opening dysfunction have been partially clarified, the potential role of psychological factors such as kinesiophobia remains understudied. Based on the fear-avoidance model, this study aimed to explore the correlations among limited mouth opening symptoms, maximal interincisal opening (MIO), and temporomandibular kinesiophobia in postoperative oral cancer patients, and to further investigate the indirect effect of temporomandibular kinesiophobia between limited mouth opening symptoms and MIO.

methodsThis cross-sectional study recruited 305 patients with oral cancer in Hunan, China, from April to June 2025. All participants completed assessments at one month after surgery. Maximal Incisal Opening (MIO), the Gothenburg Trismus Questionnaire (GTQ), and the Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD) were used for data collection. Correlations among the three variables were analyzed, and the indirect effect of mandibular kinesiophobia was further explored.

resultsCorrelations were observed among the Gothenburg Trismus Questionnaire (GTQ), the Tampa Scale of Kinesiophobia for Temporomandibular Disorders (TSK-TMD), and the MIO scores. MIO was negatively correlated with GTQ (r = - 0.696, p < 0.01) and TSK-TMD (r = - 0.517, p < 0.01), while GTQ and TSK-TMD were positively correlated (r = 0.471, p < 0.01). Mediation analysis revealed that temporomandibular kinesiophobia showed an indirect effect in the association between GTQ-derived limited mouth opening symptoms and MIO (β = - 0.077, 95% CI = - 0.112 to - 0.047). This indirect effect accounted for 16.52% of the total effect.

conclusionThis cross-sectional study examined the interrelationships among maximal interincisal opening, limited mouth opening symptoms, and temporomandibular kinesiophobia in postoperative oral cancer patients. Correlations existed among the three variables, and temporomandibular kinesiophobia showed an indirect effect on the association between limited mouth opening symptoms and maximal interincisal opening. These findings suggest that assessment of mandibular kinesiophobia may be a useful component of rehabilitation for patients with limited mouth opening.

Indexed as

KinesiophobiaMouth NeoplasmsPostoperative ComplicationsRange of Motion, ArticularTemporomandibular Joint DisordersAdultAgedChinaCross-Sectional StudiesFemaleHumansMaleMiddle AgedQuality of LifeSurveys and QuestionnairesIndirect effectKinesiophobiaLimited mouth openingOral cancerPostoperative period

Identifiers

PMID42631773

DOI10.1007/s00784-026-07099-w

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