Management Of Trismus Research Articles

Indigenous TrisCaRe® and Its Outcome in the Management of Trismus in Oral Cavity Cancer Patients: A Preliminary Report

Indigenous TrisCaRe® and Its Outcome in the Management of Trismus in Oral Cavity Cancer Patients: A Preliminary Report

Management of trismus using novel physiotherapy appliance: A case series

Trismus refers to the restriction of the range of movements of the jaw commonly referred to as “lockjaw”. We report case series of trismus in patients who came with chief complaint of reduced mouth opening and pain with various aetiologies. These patients were successfully treated by Shekar’s physiotherapy appliance. Thus, this novel oral physiotherapy appliance is simple, easy to use, custom made and perhaps be employed as an effective method to treat trismus.

Evaluation of Clinical Profile and Various Treatment Modalities in Oral Sub Mucous Fibrosis in North India: Our Experience.

Oral submucous fibrosis is a chronic disease affecting oral cavity and sometimes the pharynx. Etiology seems to be local irritants such as capsaicin, tobacco, areca nut and spicy foods. The main concern in this is the management of trismus and burning sensation of the oral mucosa. The aim of this study was to compare various medical treatment protocol of OSMF. 210 patients were divided randomly in 3 groups. In Group A, patients were given biweekly intralesional Hyaluronidase/Dexamethasone for 6weeks. Group B patients were given tablet Pentoxifylline 400mg TDS.Group C patients were given Eprisone hydrochloride. All three groups were given Lycopene 10,000 mcg for period of 6weeks. All patients were given topical Triamcelone for local application. The examinations for mouth opening were repeated at weekly intervals for a period of 6weeks.The most common complaint was burning sensation in 75.98% cases, difficulty in mouth opening in77.45% and difficulty in swallowing food in 61.76% cases. Group A showed improvement in 41.17% cases presenting with burning sensation followed by decreased mouth opening 39.70%. Group B showed improvement in 45.58% burning sensation, 17.64% with decreased mouth opening. Group C showed improvement in 48.52% patients having pain with spicy food, 32.35% with decreased mouth opening and 17.64% with difficulty in swallowing. We conclude that patients which received intralesional dexamethasone and hyaluronidase along with oral Lycopene showed better clinical and symptomatic improvement, and at present appears to be best non-surgical treatment.

Comparative evaluation of efficacy of muscle relaxant, vasodilator and combined intralesional steroid with hyalaronidase use in oral submucous fibrosis

Oral Sub Mucous Fibrosis (OSMF) is a disease , which predominately occurs in Indians and South East Asians. It is characterised by mucosal rigidity of varying intensity due to fibroelastic changes of the juxta-epithelial layer, resulting in a progressive inability to open mouth. The main concern in the condition is the management of trismus and burning sensation of oral mucosa. this study was conducted to compare various medical treatment protocol of OSMF, so as to arrive at definitive and effective protocol for the management of OSMF. 105 patients of OSMF attending the ENT OPD and satisfying the criteria for inclusion were enrolled for the study. The subjects were randomly divided into age sex matched into three study groups( Dexa with hyaluronidase , Oral vasodilator, Muscle relaxant) in which the relief in symptoms was noted. Lycopene was given in all patients. Group A, patients were given intralesional injection Dexamethasone with Hyaluronidase biweekly for five weeks and marked improvement was seen in cases of pain with spicy food 13 cases (76.47%), followed by decreased in mouth opening 9 cases (56.25%). In Group B, oral vasodilator Tablet Pentoxifylline 400 mg TDS was given and showed improvement in difficulty in protruding tongue in 9 cases (60%), pain with spicy food 8 cases (50%), decreased mouth opening 6 cases (37.5%), oral ulceration 3 cases (42.85%). In Group C with muscle relaxant Tablet Myosone 50 mg BD showed improvement pain with spicy food 8 cases (42.10%), decreased mouth opening 8 cases (42.10), difficulty in swallowing 3 cases (37.5%). As there is still paramount of controversy regarding the ethology of OSMF there is no definite treatment protocol. Patients which received intralesional dexamethasone and hyaluronidase along with oral lycopene showed better clinical and symptomatic improvement in comparison to others groups, which at present appears to the best option for OSMF.

Association of Trismus With Quality of Life and Swallowing in Survivors of Head and Neck Cancer.

We aim to (1) determine the prevalence and predictors of trismus and (2) examine the relationship of trismus, swallowing dysfunction, and quality of life (QOL) in survivors of head and neck cancer (HNC). Case series with chart review. Multidisciplinary HNC survivorship clinic. Data on trismus and patient-reported outcomes were obtained from survivors of HNC between December 2016 and October 2019. Trismus was defined as a maximum interincisal opening ≤35 mm. QOL and swallowing dysfunction were measured with the University of Washington Quality of Life questionnaire and EAT-10 (Eating Assessment Tool-10), respectively. Linear regressions were applied to investigate the relationship of trismus with QOL and swallowing dysfunction. Of the 237 survivors, 22.78% (n = 54) had trismus. Advanced stage of cancer (stage III/IV vs Tis-II, P = .002) and treatment (nonsurgical and surgery + adjuvant treatment vs surgery only, P = .006) were correlated with a higher prevalence of trismus. After controlling for cancer stage and treatment type, EAT-10 scores for survivors with trismus were 9.342 (95% CI, 6.262-12.423; P < .0001) higher than those without trismus. The University of Washington Quality of Life Physical and Social-Emotional subscales for patients with trismus were 14.088 (95% CI, 9.042-19.134; P < .0001) and 10.470 (95% CI, 4.793-16.147; P = .0003) lower than those without trismus, respectively. Trismus is a common, treatment-related consequence and is associated with increased symptoms of dysphagia and decreased QOL. Early detection and management of trismus in survivors of HNC are essential to optimize QOL and reduce morbidity.

Use of Bilateral Nasolabial Flaps with Coronoidectomy as a Novel Approach to a Case of Oral Cancer with Severe Trismus.

Patients with oral malignancy often have associated trismus. Trismus is a debilitating condition that needs to be treated adequately with the release of fibrosis and interposition of vascularized tissue to provide long-term improvement in the mouth opening. Treatment of oral cancer in patients with severe trismus becomes challenging because of difficult access and further deterioration of mouth opening following treatment of the malignancy. Herein, the planning of access to oral cancer and management of trismus in 9 oral cancer patients with severe trismus using nasolabial flaps and coronoidectomy are described. Bilateral nasolabial flaps and coronoidectomy were used successfully as an approach in these 9 patients with oral carcinoma with severe trismus. The advantages of this procedure are described.

Acute onset trismus in a 15-year-old

Trismus can be a common complaint encountered in general dental practice. A 15-year-old female presented to the Emergency Department with a history of acute onset and worsening trismus, pain and extra-oral swelling following placement of a restoration in the lower right first molar tooth. An initial diagnosis of trismus associated with either muscular spasm or a haematoma following an inferior alveolar nerve (IAN) block was assumed. The patient was reviewed the following week, the trismus and swelling having increased. An urgent MRI scan showed a large heterogeneous mass in the right masticator space. A biopsy under general anaesthetic diagnosed a rhabdomyosarcoma. The patient was referred to the oncology team for chemo/radiotherapy treatment. CPD/Clinical Relevance: Although ‘common things occur commonly’, it is important to remember that common symptoms and presentations can lead to more rare diagnoses. Prompt referral for specialist advice needs to be sought should first line management of trismus prove to be unsuccessful.

Prospective evaluation of relationships between radiotherapy dose to masticatory apparatus and trismus

Aims: This feasibility study aimed to identify relationships between radiation doses to the masticatory apparatus as a combined block or as individual subunits with changes in trismus following radiotherapy.Material and methods: Twenty patients from a single center were recruited prospectively as part of a randomized trial comparing proactive exercises in the management of trismus. Patients with stage III/IV oral cavity or oropharyngeal squamous cell cancers received intensity-modulated radiotherapy with concurrent systemic therapy. All patients had trismus prior to radiotherapy. Maximal inter-incisor distance (MID) was measured pre- and 6 months from the start of radiotherapy. Bilateral muscles of mastication: medial and lateral pterygoids (MP and LP), masseters (M), temporalis (T), temporomandibular joint (TMJ) were contoured on CT images. The block comprised all muscles excluding the TMJ below the orbital floor. Mean dose, equivalent uniform dose (EUD) and V35–V60 Gy were compared with change in MID.Results: In six patients, the MID deteriorated at 6 months from the start of radiotherapy compared with 14 whose MID improved. No significant association was observed between age, gender, smoking, alcohol status, exercise compliance, cisplatin, tumor site, stage, V35–V60 Gy or EUD with change in MID. A clinical outlier was excluded. Without the outlier (n = 19), a significant association was seen between mean dose and change in MID at 6 months for the ipsilateral block (p = .01), LP (p = .04) and M (p < .01). All patients where trismus deteriorated at 6 months received mean doses >40 Gy to the block.Conclusion: Higher mean radiation doses to the ipsilateral block, LP and M were significantly associated with deterioration in trismus. Limiting dose to these structures to ≤40 Gy for tumors not invading the masticatory muscles may improve treatment-related sequelae. The ipsilateral block, LP and M should be studied further as possible alternative avoidance structures in radiotherapy treatment planning.

Management of trismus by masseter myotomy

Mild trismus after parotid gland surgery may be related to inflammation and fibrosis of the masseter muscle. We present a case of long standing trismus due to masseter muscle spasm caused by a recurrent pleomorphic adenoma. As the patient did not agree for removal of the pleomaorphic adenoma, owing to the risk of injuring the facial nerve, a masseter myotomy with inter-positioning of temporalis fascia was planned for symptomatic relief. Mouth opening showed significant improvement even 1 year post-operatively.

A systematic review of trismus induced by cancer therapies in head and neck cancer patients

This systematic review represents a thorough evaluation of the literature to clarify the impact of cancer therapies on the prevalence, quality of life and economic impact, and management strategies for cancer-therapy-induced trismus. A systematic literature search was conducted with assistance from a research librarian in the databases MEDLINE/PubMed and EMBASE for articles published between January 1, 1990 and December 31, 2008. Each study was independently assessed by two reviewers. Taking into account predetermined quality measures, a weighted prevalence was calculated for the prevalence of trismus. The level of evidence, recommendation grade, and guideline (if possible) were given for published preventive and management strategies for trismus. We reviewed a total of 22 published studies between 1990 and 2008. Most of them assessed the prevalence of this complication, and few focused on management. The weighted prevalence for trismus was 25.4% in patients who received conventional radiotherapy and 5% for the few intensity-modulated radiation therapy studies. No clear guideline recommendations could be made for the prevention or management of trismus. Newer radiation modalities may decrease the prevalence of trismus compared to conventional radiotherapy. Few studies have addressed the quality of life impact of trismus, and no studies were identified to assess the economic impact of trismus. The few preventive and management trials identified in the literature showed some promise, although larger, well-designed studies are required to appropriately assess these therapies before recommendations can be provided.

The aetiology and pathogenesis of trismus

Review: The aetiology and pathogenesis of trismus The word trismus, from the Greek ‘trismos’, is defined as a prolonged, tetanic spasm of the jaw muscles by which the normal opening of the mouth is restricted (locked jaw). The designation was originally used only in tetanus, but as inability to open the mouth may be seen in a variety of conditions, the term is currently used in restricted jaw movement regardless of aetiology.1 As the literature on the subject mainly consists of case reports, the authors have reviewed the pathogenesis, aetiology and management of trismus

The aetiology and pathogenesis of trismus.

The word trismus, from the Greek 'trismos', is defined as a prolonged, tetanic spasm of the jaw muscles by which the normal opening of the mouth is restricted (locked jaw). The designation was originally used only in tetanus, but as inability to open the mouth may be seen in a variety of conditions, the term is currently used in restricted jaw movement regardless of aetiology. As the literature on the subject mainly consists of case reports, the authors have reviewed the pathogenesis, aetiology and management of trismus.