Update and request guidance...

My father went through the surgery - wide excision of the tumor + marginal mandibulectomy, defects covered intra-orally with tongue flap. The margins were very close, less than 0.1mm - which pretty much means the surgeon was not able to completely take the cancer out. Good news is the biopsy report shows no perineural invasion, no extra capsular spread and the bone is not involved.

He is now going through 30cycles of IMRT to the tumor bed and all the area from parotid glands to sub-mandibular salivary glands and also to the lymphatic channels - as he had the lymph nodes taken off during the first surgery.

The above has resulted in severe trismus to the extent that the gap has now reduced to less than one finger. We have about 6 radiation sessions pending, but he is in severe pain of the lower jaw and neck area. We already had two 3-day courses for fungal infection, but the doc says his oral hygine is not good. We just got a NG tube fitted as he is finding it difficult to swallow.

Could anyone kindly provide guidance on dealing with Trismus, dealing with the last week of radiation and living through oral mucosites. Until what time will effects of radiation persist? What more should we expect as other side effects in the last week of radiation?

Regards,
Vithal