Trismus - An Aetiology and Management
Trismus - An Aetiology and Management
Trismus - An Aetiology and Management
Dr.J.Arun Kumar*
WHAT IS TRISMUS???
2. Traumatic
Trismus is derived from a Greek term Fractures of mandible, zygomatic arch or
meaning “Grinding together”. temporal bone.
It is defined in Taber’s cyclopedic medical Haematoma in the joint or muscles of
dictionary as tonic contraction of muscles of mastication.
mastication. Local anaesthetic injection or injury.
True trismus is a muscular involuntary Paradoxical muscle sparm following head
protective reflex. injury.
As a result of localised muscle irritation or Post-surgical. Eg: TMJ surgery, 3rd molar
inflammation afferent signals of pain and input extraction.
from reset muscle spindles to the central nervous
system cause foreshortening of the muscles of
mastication.
This is different from voluntary muscular
guarding that can occur in patients with a TMJ
internal derangement.
Such patients resist normal opening due to
joint pain and dysfunction.
3. Neoplastic (Benign)
ETIOLOGY Tumors involving TMJ & surrounding
structures. Eg: Osteochondroma.
Odontogenic infection. Hyperplasia of condyle or coronoid process.
Multiple inferior alveolar nerve anaesthetic
injection.
Masticatory muscle disorder (Acute
exacerbation).
Surgery. Eg: Third molar extraction.
Trauma with mandibular fracture or muscle
contusion.
Neoplasia irritating or invading muscles of
mastication.
Radiation treatment.
Psychologic hysterical trismus.
Pharmacologic phenothiatines.
Neuromuscular tetanus.
CLASSIFICATION
4. Neoplastic (Malignant)
Trismus can be classified in the etiologic basis. Chondrosarcoma.
Osteosarcoma.
1. Congenital Cerebellopontine angle tumor.
Birth injury Tumors of oropharynx.
Trismus pseudo camptudacrtyly syndrome Metastatic tumors involving mandible and
Arthrogryposis multiplex congenita infratemporal fossa.
* Senior Lecturer
CLINICAL FEATURES
Trismus is usually acute in onset, unilateral,
painful, and associated with an identifiable cause.
When a patient presents with trismus, history
and clinical examination are of paramount
importance in arriving at a diagnosis.
While taking history, the following questions
should be asked
Osteomyelitis of mandible and temporal bone. How long the trismus was present?
Abcesses of the submasseteric, lateral Is there history of trauma or
pharyngeal, pterygomandibular, sub-mandibular infection?
and temporal spaces. Is it of slow or sudden onset?
Tonsillitis and peritonsilar abscess. Is it progressive?
Parotid abscess. Is there any systemic disease?
Mumps. Is the patient currently receiving any
Cancrum oris. medication?
Encephalitis. Is there any associated pain?
Meningitis. Are there any swellings?
SIGNS: Most obvious effect of trismus is difficulty in
7. Reactive (Chronic) opening the mouth. Regardless of the cause.
TMJ ankylosis (Fibrous and bony)
TREATMENT OPTIONS
Treatment should be as soon as possible.
Therabite jaw motion rehabilitation system.
TREATMENT Trismus appliances
(a) Cork screw
To know how to treat this condition we should (b) Tongue blade
first concentrate. (c) E-Z flex jaw exerciser
WHEN DOES TRISMUS START?
WHAT ARE THE RISK FACTORS?? PROTOCOL
Severity of the condition varies from no
limitation in opening to 4 or 5 mm. Recent research of the university of Pittsburgh
has shown that passive motion provides significant
The severity of the condition varies reduction in inflammation and pain.
- With the placement of radiation. Passive motion applied several times per day
- The amount of radiation received. is more effective than static stretching.
- Patient’s own ability to tolerate the treatment. Before starting the treatment its important to
- Radiation in excess of 60 Gr. is more likely to measure initial opening and record the opening.
cause trismus. Also, record the opening after each session,
X-patients who are previously irradiated and and note any pain or discomfort as well as the
who are being treated for recurrence, appear to number of exercises performed.
be at high risk than those who are receiving their
first treatment. THERABITE
Radiation induced trismus may begin towards
the end of radiation treatment or anytime during It comes with
subsequent 12 months. Bite pads
Trismus due to scarring and edema after Patented range of molar scales
surgery. Patient log-book.
Inspite of the difference in the cause of
condition, diagnosis & treatment is similar for
both the type of patients.
MECHANISM
Therabite system not only stretches the
connective tissue, but also allows for proper
mobilization of the temporomandibular joint. Pump portion of EZ Flex
1. Increase jaw opening Stretching connective tissue
via
- Lengthening and realigning muscle and
collagen fibers.
- Mobilizing joints that have shown
degenerative changes.
- Strengthening muscles across their full range EZ Mouth – The jaw portion of the EZ Flex opening the
of motion. patient’s mouth
2. Reduce pain and inflammation by activating anti-
inflammatory properties by passive mobilization of the
joints.
TRISMUS APPLIANCES
CORKSCREW
Can be used to exercise a patient’s mouth EZ Measure – Measuring the Jaw Opening
opening when under going radiation treatment
with TMJ in the radiation field.
This device works by gradually opening the
jaw when the patient places it between the teeth
and turns the corkscrew.
Patient does this several times a day.
EZ Flex Kit
CONCLUSION
TONGUE DEPRESSOR
Least expensive
Trismus is associated with various etiologies.
An early diagnosis with prompt treatment will usually www.ominimedicalsearch.com
result in a complete cure. Disorders of Temporomandibular Joint and
Muscles of Mastication.
REFERENCES Textbook of Oral Medicine - Promod John