There may also be associated symptoms such as headache, jaw pain, ear ache, deafness, or pain on moving the jaw. In cases of trismus caused by radiation treatment, patients also frequently present with Xerostomia, mucusitis, and pain as a result of radiation burns. Difficulty in speech and swallowing often accompany the limitation in mouth opening, and create a combination of symptoms that may be difficult to treat. In stroke patients, the general cause is central nervous system dysfunction. As discussed above, in cancer patients this frequently results from scar tissue from radiation or surgery, nerve damage, or a combination of factors. The most obvious effect of trismus is difficulty in opening the mouth. Thus treatment, consisting of gentle passive motion, should begin as soon as practicable. In the case of patients receiving radiation treatment of the head and neck, trismus may progress slowly, even unnoticed for months, causing secondary changes to both muscles and joints. Similarly, joints which are immobilized quickly begin to show degenerative changes in the joint, including thickening of synovial fluid and thinning of cartilage. Studies have shown that muscles that fail to move through their range of motion for as little as three days begin to show signs of atrophy. Regardless of the immediate cause, mandibular hypomobility will ultimately result in both muscle and joint degeneration. Gentle, passive motion has been shown to be efficacious in treating the condition. Rapid motion may create the reflex that causes muscles to contract, thereby making stretching of connective tissue difficult or even impossible. Thus, in treating this condition it is important to recall that rapid motion, or the use of powerful forces may be self-defeating. This contraction is truly a reflex it cannot be controlled by the patient. This pain causes the muscles to contract, resulting in loss or range of motion. This condition, called “muscle guarding” results when muscle fibers engender pain when they are stretched. When any muscle is damaged, a pain reflex may be stimulated. Each muscle plays an important role in mastication, and when damaged, each can cause limitations in opening. The muscles of mastication (also called the ‘elevator muscles’) consist of the Temporalis, Masseter, Medial pterygoid and Lateral pterygoid. Tetanus, lesions that affect the trigeminal nerve and drug toxicity may all be suspects in this condition.įinally, there are iatrogenic causes, such as third molar extraction (in which the muscles of mastication may be torn, or the joint hyperextended) hematomas secondary to dental injection and late effects of intermaxillary fixation after mandibular fracture or other trauma. Limitations caused by factors internal to the joint include bony ankylosis (bony in growth within the joint), fibrous ankylosis, arthritis, infections, trauma and (perhaps) micro-trauma that may include brusixm.Ĭentral Nervous System disorders can also cause limitations to mouth opening. Limitations caused by factors external to the joint include neoplasms, acute infection, myositis, systemic diseases (lupus, scleroderma, and others) pseudoankylosis, burn injuries or other trauma to the musculature surrounding the joint. scarring) or a combination of these factors. The limitation in opening may be a result of muscle damage, joint damage, rapid growth of connective tissue (i.e. Limited jaw mobility can result from trauma, surgery, radiation treatment, or even TMJ problems. Oral hygiene is compromised, chewing and swallowing is more difficult, and there is an increased risk of aspiration. It may make physical re-examination difficult, if limited mouth opening precludes adequate visualization of the site. Severe trismus makes it difficult or impossible to insert dentures. Not only is it difficult to speak with the mouth partly closed, thus impairing articulation, but trismus can decrease the size of the resonating oral cavity and thus diminish vocal quality. Communication is more difficult when one is suffering from trismus. Trismus can dramatically affect quality of life in a variety of ways. In persons who have received radiation to the head and neck, the condition is often observed in conjunction with difficulty in swallowing. This limitation in the ability to open the mouth can have serious health implications, including reduced nutrition due to impaired mastication, difficulty in speaking, and compromised oral hygiene. More recently, the term ‘trismus’ has been used to describe any restriction to mouth opening, including restrictions caused by trauma, surgery or radiation. In the past, this word was often used to describe the effects of tetanus, also called ‘lock-jaw’. Trismus is defined in Taber’s Cyclopedic Medical Dictionary as a tonic contraction of the muscles of mastication.
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