Cause Of Trismus Research Articles

Challenges in Managing Post-Radiation TMJ Pseudoankylosis.

This study demonstrates the outcomes of post-radiation temporomandibular joint (TMJ) pseudoankylosis management and its challenges. A rare maxillary squamous cell carcinoma was treated with subtotal maxillary resection. Subsequent radiation therapy, failure of free flap reconstruction, and 1 year of jaw hypomobility instigated TMJ pseudoankylosis with a maximal mouth opening (MMO) of less than 5mm. Bilateral coronoidectomy was done simultaneously with maxillary reconstruction, followed up with buccal fibrosis release and extensive jaw exercises. At 16 months of follow-up, the patient's MMO was 20mm. Although bilateral coronoidectomy released the attachment of the atrophic temporalis muscle, it did not correct the other causes of trismus, specifically the progressive fibrosis of masticatory muscles, loss of elasticity of the TMJ ligaments, and other soft tissue abnormalities. Radiotherapy-induced-trismus refractory to physical exercise may require further management to achieve satisfactory MMO.

Mechanical Obstruction by Malposed Upper Third Molar: A Rare Cause of Trismus

Trismus is a multifactorial symptom which is most commonly presented after the removal of lower third molars. Upper third molar is a rare but true cause of trismus and must be included in the differential diagnosis. We present a rare case of trismus caused by the presence of malposed upper third molar, obstructing the forward movement of coronoid process of the mandible and restricting further mouth opening.

64. Buccally positioned and misaligned bilateral maxillary third molars impinging on coronoid process- a rare finding and unreported cause for long term Trismus

Trismus refers to the restriction of the range of motion of the jaw and functionally limiting and posed significant challenge in patient’s day-to-day function and quality of life. Extra-articular and intra-articular causes of trismus have been described in literature. We present a rare and unusual and previously unreported case of bilateral maxillary third molars causing limitation of mouth opening and jaw function.

Multicentric Castleman disease with trismus.

A 58-year-old man visited our hospital with trismus and anorexia in the past 1 month (Fig. 1A, B). Multicentric Castleman disease was suspected due to cervical and axillary lymphadenopathy on CT, a high inflammatory response and IL-6 level elevation. Lymph node biopsy revealed mantle zone development, interfollicular expansion, extensive plasma cell infiltration and cluster of differentiation 3-positive (CD3+) T cell accumulation, leading to the diagnosis of plasmacytic Castleman disease. CT findings could not explain the cause of trismus (Fig. 1C). PET-CT revealed increased fluorodeoxyglucose uptake in the right temporomandibular joint, implicating temporomandibular joint arthritis as the cause of trismus (Fig. 1D, arrow). Trismus rapidly improved after prednisolone and IL-6 inhibitor administration. Similar to RA, Castleman disease is a lymphoproliferative disease with IL-6–related systemic inflammation. Temporomandibular joint arthritis is an articular symptom of RA, but arthritis in Castleman disease has rarely been reported. Activation of CD3+ cells by IL-6 is a potential mechanism of arthritis [1]. CD3+ T cells were clearly observed in the lymph nodes in our patient, which indicates arthritis. We report a case of trismus associated with temporomandibular arthritis, which we consider to be highly representative of the pathophysiology of Castleman disease.

Systemic and Local Effects Among Patients With Betel Quid-Related Oral Cancer.

The major predisposing factors of developing oral cancer include smoking, alcohol drinking, and betel quid chewing. Betel quid chewing could cause the abrasion and damage of oral mucosa by crude fibers, chemical insults by additive slaked lime, and arecoline from areca nut. These would lead to the local consequence of oral submucosal fibrosis, which is regarded clinically as a precancer lesion and a major cause of trismus. In addition, the components and additives in betel quid contain chemical toxins and carcinogens, which would further affect the oral mucosa and gradually develop a malignancy. Following literature review, aside from having a greater total tumor burden and more local diseases in the oral cavity and digestive tract, patients with betel quid-related oral cancer also have more systemic diseases from metabolic syndrome, hypertension, cardiovascular disease, type II diabetes mellitus, and obesity than those without this habit. In conclusion, those patients who have the history of smoking, alcohol drinking, and betel quid chewing would present much more unique clinical characteristics than those who only have a history of smoking and alcohol drinking. More attention should therefore be paid to pretreatment evaluation, treatment strategy, and posttreatment follow-up among betel quid chewers.

Effect of Local Anesthesia and Extraction on Mouth Opening

Background: Trismus is defined as painful limitation in mouth opening due to a muscle spasm. Trismus, also called lockjaw, (restricted jaw range of motion).There are various causes of trismus, one is spasm of the muscles of mastication. Assessment of the effect of local anesthesia and extraction on mouth opening ability. Methodology: Total sample of 40 patients included both genders (27 male and 13 female) participated in this study, all Patients were healthy with no allergy to local anesthesia, don’t use alcohol or any drug therapy. Lidocaine HCL 2% with epinephrine 1:80,000 is used to anesthetize the inferior alveolar nerve using IAN block technique, while surgical tools were used for extraction in the usual way. Baseline mouth opening was evaluated pre-operatively, during the effect of local anesthesia and post-operatively by using digital Vernier caliper. Results: significant difference in mouth opening between the measurements (pre-operative, during anesthesia, post-operative) is found , mouth opening decreases when measurement is directed toward postoperatively.

Sphenoid sinusitis as a possible cause of trismus

Sphenoid sinusitis as a possible cause of trismus

Trismus secondary to valproate treatment in a woman with bipolar disorder: a case report

Muscle contracture is a common symptom of valproate. However, there is no report in the literature of lockjaw (trismus) associated with this drug. We therefore present a case of lockjaw during valproate treatment in a patient with bipolar disorder and hypoparathyroidism.A 62-year-old Caucasian female was admitted on November, 2015 at a psychiatric unit during a manic episode. Patient was previously diagnosed with bipolar disorder and had manic and depressive episodes in the past. She underwent a total thyroidectomy three months prior to her admission, for suspicion of malignancy (not confirmed by biopsy) and has been since then in treatment for hypothyroidism and iatrogenic hypoparathyroidism with levothyroxine, calcitriol and calcium carbonate. She had no cognitive impairment and no relevant findings in laboratory exams. A cerebral perfusion scintigraphy was performed showing slight hypoperfusion in the frontal lobe and posterior cerebellar areas. It is noteworthy that the patient did not tolerate lithium carbonate due to severe extremity tremors. Therefore, valproate was initiated and gradually increased up to 1000 mg/day. She developed lockjaw three days after. She was unable to open her mouth and also fractured two teeth. She had difficulty in diction and in chewing food. No painful symptom or other muscular manifestation had been reported. Biperiden and clonazepam were prescribed without response. She had no prior symptoms of muscular spasm and she denied previous use of valproate. The diagnosis of valproate-induced trismus was made after other causes of trismus, such as infections, neurological illness and oro-dental abnormalities were excluded. The laboratory tests show no alterations on serum levels of TSH, PTH, phosphate and calcium. Thus, the valproate was replaced by olanzapine, which lead to symptom resolution. Patient has been in follow-up for two years and did not have any trismus symptoms since valproic acid withdrawal.Trismus is defined as a tonic contraction of the muscles of mastication with mouth opening of ≤ 35 mm

Outcomes of coronoidectomy as treatment of coronoid pseudoankylosis and hyperplasia: case series

Background: The coronoid process may play an important role as an underlying cause of trismus due to its anatomical position in relation to the zygomatic arch, however patients rarely present with coronoid related underlying causes. We are presenting a case series of seven patients with mandibular hypomobility due to coronoid hyperplasia and traumatic coronoid pseudoankylosis. Objectives: To evaluate the effectiveness of coronoidectomy as a treatment for severe mandibular hypomobility in cases of developmental coronoid hyperplasia and traumatic coronoid pseudoankylosis. Methods: Seven patients clinically diagnosed with severe mandibular hypomobility (10–20 mm) were treated in our hospital from 2008 till 2015. Four patients had pseudoankylosis of the coronoid process with the untreated-fractured zygoma. Three patients had bilateral coronoid hyperplasia, with one case forming a bilateral joint articulation with the zygoma (Jacob's disease). All patients underwent coronoidectomy. Surgery was followed by vigorous jaw physiotherapy. Patients were evaluated using interincisal distance at maximum mouth opening, preoperatively and postoperatively for a period ranged between 6 months and 2 years. Findings: Mandibular mobility improved significantly in six patients postoperatively and was maintained throughout the follow up period with satisfactory range of motion (30–42 mm). Postoperative recovery was uneventful, however two patients had significant iatrogenic postoperative deranged occlusion, and one had re-pseudoankylosis six months postoperatively despite initial improvement. Conclusion: Coronoidectomy is an effective measure for treatment of coronoid hyperplasia and coronoid pseudoankylosis, with minimum complication.

Upper third molar causing mechanical obstruction of mouth opening: A true but rare cause of trismus

Upper third molar causing mechanical obstruction of mouth opening: A true but rare cause of trismus

A study of the factors affecting radiation-induced temporomandibular joint changes in post-radiotherapy nasopharyngeal carcinoma patients

Background Radiotherapy of nasopharyngeal carcinoma (NPC) often delivers considerable radiation dose to the temporomandibular joint (TMJ). This may lead to radiation-induced trismus, which can have impact on the quality of life of post-radiotherapy (post-RT) patients. However, the exact cause of trismus and its relationship with dose has not been fully understood. This study aimed to evaluate the quantitative relationship between severity of post-RT trismus and TMJ doses and other patient characteristics. Through ultrasound examination, this study also aimed to identify factors affecting morphological changes of TMJ.

Dose-volume factors correlating with trismus following chemoradiation for head and neck cancer

Background. To investigate the dose-volume factors in mastication muscles that are implicated as possible causes of trismus in patients following treatment with intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy for head and neck cancers.Material and methods. All evaluable patients treated at our institution between January 2004 and April 2009 with chemotherapy and IMRT for squamous cell cancers of the oropharynx, nasopharynx, hypopharynx or larynx were included in this analysis (N = 421). Trismus was assessed using CTCAE 4.0. Bi-lateral masseter, temporalis, lateral pterygoid and medial pterygoid muscles were delineated on axial computed tomography (CT) treatment planning images, and dose-volume parameters were extracted to investigate univariate and multimetric correlations.Results. Forty-six patients (10.9%) were observed to have chronic trismus of grade 1 or greater. From analysis of baseline patient characteristics, toxicity correlated with primary site and patient age. From dose-volume analysis, the steepest dose thresholds and highest correlations were seen for mean dose to ipsilateral masseter (Spearman's rank correlation coefficient Rs = 0.25) and medial pterygoid (Rs = 0.23) muscles. Lyman-Kutcher-Burman modeling showed highest correlations for the same muscles. The best correlation for multimetric logistic regression modeling was withV68Gy to the ipsilateral medial pterygoid (Rs = 0.29).Conclusion. Chemoradiation-induced trismus remains a problem particularly for patients with oropharyngeal carcinoma. Strong dose-volume correlations support the hypothesis that limiting dose to the ipsilateral masseter muscle and, in particular, the medial pterygoid muscle may reduce the likelihood of trismus.

Trismus in the paediatric population.

Trismus is a rare presentation affecting neonates, children, and adults. In newborns there are serious implications, with potential to affect feeding, cause airway problems, and make intubation difficult. Causes of trismus seen in the paediatric patient are discussed in this review article; they are divided into intra- and extra-articular types. The extra-articular group consists of congenital and acquired disorders. The acquired group includes infective causes such as tetanus, iatrogenic causes related to drugs, cancer or dental treatment, and trauma causing articulation difficulty or triggering a rare type of bone growth in myositis ossificans. Changes in the mouth resulting from oral submucous fibrosis can undergo malignant transformation. This review aims to raise awareness of potential causes of trismus in paediatric populations, helping clinicians identify the underlying pathology so appropriate strategies for treatment be applied, with the ultimate aim of improving long-term outlook and quality of life for affected children.

Unusual causes of trismus: a report of two cases

Chronic inability to achieve normal mouth opening can be a symptom of several diseases. Mostly the causes of inability to open mouth are articular and sometimes the cause may be extra-articular. In the two cases which are being reported in this article the causes of limited mouth opening are extra-articular and that too from rare pathologies, of which one case is of OKC of the coronoid process and the other case is of myositis ossificans of the buccinator and medial pterygoid muscle. Both the cases had adequate mouth opening both intraoperatively and at long term follow up.

The use of mandibular nerve block to predict safe anaesthetic induction in patients with acute trismus*

Acute trismus can be caused by pain, muscle spasm, swelling or mechanical obstruction. Unfortunately, the cause is not always obvious during pre-operative airway assessment. In this pilot study, we prospectively evaluated mandibular nerve block as a pre-operative tool to identify patients with reversible causes of trismus, namely pain or spasm, in order to allow safe anaesthetic induction. Six patients with unilateral fractured mandibles and trismus received a mandibular nerve block before induction of general anaesthesia. There was an increase in maximal inter-incisor gap after the blocks (median (range) distance: pre-block 16.5 (14-30) and post-block 34 (32-35) mm; p = 0.027), and no further improvement after induction of general anaesthesia (post-induction 37 (30-40) mm; p = 0.276 compared with post-block). There was an improvement in pain scores (p = 0.027), and no side-effects were detected. Pre-operative mandibular nerve blockade appears to reverse trismus caused by pain and muscle spasm, allowing the anaesthetist to decide whether awake intubation is genuinely indicated.

Jaw locking after maxillofacial trauma

The purpose of this report is to present two cases of jaw locking with two different etiologies. In case #1, jaw locking occured 5.5 months after a surgical reduction and internal fixation on the fractured maxilla and mandible. Some plain radiographic x-ray were made but failed to give adequate information in establishing the cause of trismus. The three dimensional computed tomography (3D-CT) was finally made and able to help guide the pre-operative diagnosis and treatment. Two-steps gap arthroplasty were done comprising a gap arthroplasty leading to acceptable outcome. An adult patient in case #2 with a history of trauma at his childhood and bird-like face apprearance clinically, was unable to open the mouth since the time of accident. The patient was diagnosed with bilateral ankylosis of temporomandibular joints. One side (right) gap arthroplasty was done and resulted in normal mouth opening.

Masseter myodegeneration as a cause of trismus or dysphagia in adult horses

The medical records of eight horses with histological evidence of myodegeneration of the masseter muscles were examined. While they were alive their most common clinical signs had included difficulty in...

Management of ankylosis in the young child

Ankylosis and fibrous adhesions causing limited range of motion of the pediatric mandible can be a challenging problem for the oral and maxillofacial surgeon to remedy. The causes of limited range of motion in the pediatric population may be congenital, post-traumatic, neoplastic, or iatrogenic. It is important to differentiate between the many causes of trismus in the pediatric patient. Critical to the treatment planning is a detailed evaluation and diagnosis of the limited range of motion. Untreated ankylosis or recurrence can cause problems with mastication, speech, growth, and airway impairment. Treatments that have been described for ankylosis and/or adhesions include coronoidectomy, gap arthroplasty, costochondral rib reconstruction, prosthetic joint replacement, or distraction osteogenesis with transport techniques. However, controversies exist because outcome studies are sparse when one looks carefully at the many surgical options. This session will outline evaluation, differential diagnosis, and current surgical approaches for both ankylosis and fibrous adhesions of the pediatric mandible. Particular attention will be given to the controversial management of this difficult problem. References Posnick JC, Goldstein JA: Surgical management of the temporomandibular joint ankylosis in the pediatric population. Plast Reconstr Surg 91:791, 1993 Ridson F: Ankylosis of the temporomandibular joint. J Am Dent Assoc 21, 1933 Kaban LB, Perrott DH, Fisher K: A protocol for management of temporomandibular joint ankylosis. J Oral Maxillofac Surg 48:1145, 1990

Plastic trismus—A difficult diagnostic problem

There are many causes of trismus but we have only found one previously reported case similar to that presented here ( English and Hemenway, 1968)