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At least 19 recordsLinked to original sources
PubMed2006

Exercise therapy for trismus in head and neck cancer.

The aim of this study was to analyze retrospectively effects of exercise therapy on trismus related to head and neck cancer or as a consequence of its treatment, and to compare these effects with trismus not related to head and neck cancer. Medical records of patients referred to the department of physical therapy with the diagnosis trismus were retrieved and analyzed. Data of 27 patients with trismus related to head and neck cancer and data of eight patients with trismus not related to cancer were found. The number and type of exercises were registered from the records, as was the extent of mouth opening before and after exercise therapy. The median (IQR) number of exercise treatments was 4 (3-9.3). Exercises included active range of motion exercises, hold relax techniques, manual stretching and joint distraction. The increase in mouth opening was significantly (p<or= 0.05) less in the group of patients with trismus related to head and neck cancer (mean increase: 5.5, sd: 6.0) as compared to the increase in mouth opening in the group with trismus not related to cancer (mean increase: 17.1, sd: 9.0). The mean number of treatments given to the group with trismus related to head and neck cancer (7.7) and the group with trismus not related to head and neck cancer (6.1) did not differ significantly. It is concluded that trismus related to head and neck cancer is difficult to treat with exercise therapy.

Adult↗
PubMed1993

Trismus in patients with malignant tumours in the head and neck.

In order to elucidate the causal mechanism of trismus in head and neck cancer, 21 patients manifesting trismus out of 212 patients with malignant tumours in the head and neck (treated in Tokyo University Branch Hospital from 1983 to 1991) were reviewed. Nine patients developed trismus either by infiltration of the muscles of mastication or by reflex spasm. Trismus was considered to have developed as a result of irradiation in five cases and of surgical intervention in seven cases. In some cases of oropharyngeal cancer, CT revealed no evidence of tumour invasion into the infratemporal fossa when trismus occurred, suggesting that trismus was caused either by the reflex spasm of muscles or by microinvasion too small to be seen in CT films. Maxillary sinus tumours were often without trismus even when they extended posteriorly to the infratemporal fossa.

Adult↗
PubMed2004

Trismus in head and neck oncology: a systematic review.

The aim of this review was to identify systematically, criteria for trismus in head and neck cancer, the evidence for risk factors for trismus and the interventions to treat trismus. Three databases were searched (time period 1966 to June 2003) for the text "trismus" or "restricted mouth opening". Included in the review were clinical studies (> or = 10 patients). Two observers independently assessed the papers identified. In 12 studies nine different criteria for trismus were found without justifying these criteria. Radiotherapy (follow-up: 6-12 months) involving the structures of the temporomandibular joint and or pterygoid muscles reduces mouth opening with 18% (sd: 17%). Exercises using a therabite device or tongue blades increase mouth opening significantly (no follow-up), effect sizes (ES) 2.6 and 1.5 respectively. Microcurrent electrotherapy (follow-up 3 months) and pentoxifylline (no follow-up) increases mouth opening significantly (ES for both: 0.3).

Head and Neck Neoplasms↗
PubMed2001

A pilot study of pentoxifylline in the treatment of radiation-induced trismus.

Radiation-induced trismus has a significant impact on the quality of life of patients receiving radiotherapy for head and neck cancers. Pentoxifylline has immunomodulatory activities that downregulate certain cytokines that have been implicated as mediators of fibrogenic reactions after radiation. A pilot study was therefore conducted to evaluate the efficacy of pentoxifylline in the treatment of radiation-induced trismus. Twenty patients with severe trismus (dental gap < or = 25 mm) after receiving radiotherapy for nasopharyngeal carcinoma were enrolled onto the study. Four patients were excluded from analysis because of poor drug compliance. The remaining 16 evaluable patients completed an 8-week course of pentoxifylline at a dose of 400 mg two to three times daily. Changes in dental gap were recorded by measuring the distance between left upper and lower incisor before and after treatment. At the end of treatment, 10 patients had a measured increase in dental gap ranging from 2 to 25 mm. Six patients had an increment of 5 mm or more. The mean dental gap before treatment was 12.5 mm compared with 16.5 mm at the end of treatment (p = 0.023). The mean difference in dental gap was 4 mm, with a 95% confidence interval of 0.6 to 7.4 mm. The drug pentoxifylline appears to exert a modest therapeutic effect in patients with radiation-induced trismus, although our findings need to be confirmed by a randomized placebo-controlled study. While awaiting more evidence from clinical studies, a therapeutic trial of pentoxifylline is worth considering in patients experiencing radiation-induced trismus.

Adult↗
PubMed2006

Release and free flap reconstruction for trismus that develops after previous intraoral reconstruction.

BACKGROUND: Oral cancer patients receive wide excision of oral structures and reconstruction of the intraoral defects with skin grafts and/or local, regional, or free flaps. Trismus is a common postoperative sequela, even without postoperative radiotherapy. Trismus decreases patients' quality of life and can have detrimental effects on their oral hygiene and nutritional status. METHODS: Between May of 1999 and June of 2003, 11 patients were operated on for release of trismus and reconstruction after previous intraoral reconstructions. The patients had been reconstructed with skin grafts (n = 4), radial forearm flaps (n = 3), anterolateral thigh flaps (n = 1), artificial dermis (n = 1), radial forearm flaps with skin grafts (n = 1), and pedicled pectoralis major flaps with skin grafts (n = 1). Eight patients had received postoperative radiotherapy. The patients presented with a mean interincisal distance of 3.1 mm (range, 0 to 10 mm). RESULTS: After trismus release, the intraoral soft-tissue defects were reconstructed with one or two free flaps (six anterolateral thigh flaps, nine forearm flaps, and one fibula osteoseptocutaneous flap). Fifteen of the 16 flaps were successful, with one flap failure. Average interincisal distance was 33.4 mm immediately after the release (range, 27 to 35 mm) and 18.9 mm (range, 5 to 30 mm) at a mean follow-up time of 22.7 months (16.1 mm in the radiated group and 26.3 mm in the nonradiated group). The mean amount of improvement was 15.8 mm. CONCLUSION: The use of free flaps to reconstruct the defects created after trismus release in patients with previous intraoral reconstruction is a viable option that yields reasonable, long-lasting improvements in mouth opening, intraoral hygiene, and quality of life.

Aged↗
PubMed2005

The influence of cryotherapy on reduction of swelling, pain and trismus after third-molar extraction: a preliminary study.

BACKGROUND: Swelling, pain and trismus are undesirable consequences of impacted mandibular third-molar extraction. The authors conducted a study to evaluate the effectiveness of cryotherapy, the therapeutic use of cold, in reducing undesirable consequences after surgery. METHODS: Fourteen patients aged 20 to 28 years comprised the sample. The authors extracted two impacted mandibular third molars at different times from each patient. Immediately after surgery, the patient underwent cryotherapy on one side for 30 minutes every one and one-half hours for 48 hours when he or she was awake. The patient did not receive cryotherapy on the other side. The authors performed clinical examinations to measure trismus and swelling before surgery, immediately after surgery and 24 and 48 hours after surgery. RESULTS: The authors compared both sides for differences in swelling, pain and trismus in each patient. The results showed significant statistical differences in two of the five points that were used to measure the swelling (Wilcoxon nonparametric signed rank test of linear distances between the angle of the mandible to the pogonion and to the tragus). They found statistical differences between the two sides in relation to the pain; however, they found no significant differences in relation to trismus. CONCLUSIONS: Cryotherapy was effective in reducing swelling and pain in this sample. Despite playing no role in the reduction of trismus, cryotherapy was effective in reducing swelling and pain in this sample, and the authors still recommend it be used. CLINICAL IMPLICATIONS: Cryotherapy is helpful after third-molar extraction. Further studies need to be conducted that use larger samples of patients and other types of therapy, such as low-level laser therapy.

Adult↗
PubMed1998

[Is a maxillary prosthesis difficult for patients with trismus?].

Of patients with a postoperative maxillary defect, around 30% are though to have trismus to some extent. In these patients, some difficulty in fabricating a maxillary prosthesis is expected. In this study, 54 patients with trismus were compared with a control group to find some proof of difficulty in making a maxillary prosthetics. Fifty-four of trismus less than 20 mm of a mandibular stroke were experienced out of 185 patients with maxillary prosthetics between October 1984 and October 1992. The trismus was divided into 4 groups of less than 5 mm (1 case), 5 mm-10 mm (10 cases), 11 mm-15 mm (19 cases), and 16 mm-20 mm (24 cases). These case were analyzed by in taking an impression failure, average weight of the prosthesis, time needed to complete the prosthesis and some special form of prosthesis. No apparent differences among the 4 groups or with the control group were found. The cause of the difficulty in making a prosthesis for such patients with trismus are suggested not to be simply due to the range of mouth opening but also to the complexed space formed by the dental defect, alveolar bone defect, spreadability of the lip and the cheek, the mandibular stroke and the so-called scar bundle of the cheek next to the defect.

Adult↗
PubMed1992

Evaluation of trismus after treatment of mandibular fractures.

This retrospective study examines the effects of treatment modalities and other contributing factors on the duration of trismus following mandibular fractures. Under a strict protocol, 80 cases involving a total of 120 fractures and their treatment modalities were reviewed. An investigation of duration of trismus was carried out in several ways. Although a relationship was established between age, initial interincisal distance, and duration of trismus, no relationship was found with the number or location of fractures, or reduction method. However, after examining the fixation methods separately, it was found that those cases in which Champy plates were used experienced a shorter duration of trismus compared with those using closed reduction with maxillomandibular fixation.

Adolescent↗
PubMed2004

Coronoidectomy in maxillary swing for reducing the incidence and severity of trismus--a reminder.

PURPOSE: The maxillary swing approach is a proven method for access to the nasopharynx. However, often, trismus is incurred postoperatively, hampering adequate oral care and follow-up and affecting patients' quality of life. CASE REPORTS: Coronoidectomy was performed in four patients undergoing maxillary swing. Minimal trismus was seen in one patient undergoing repeat irradiation and chemotherapy. After a 1-month period no trismus was observed in the other three patients. CONCLUSION: Coronoidectomy, usually performed in maxillectomy for reducing trismus is a useful adjunct in the maxillary swing procedure.

Humans↗
PubMed1997

Trismus and pain after removal of impacted lower third molars.

PURPOSE: This study evaluated trismus and pain after removal of impacted lower third molars and investigated whether these responses were related to difficulty of surgery. PATIENTS AND METHODS: A consecutive series of 104 patients, all of whom underwent removal of an impacted lower third molar under local surgery, was studied. Difficulty of surgery was evaluated on a modified version of the Parant scale: I, extraction with forceps only; II, extraction by ostectomy; III, extraction by ostectomy and coronal section; IV, complex procedures. Trismus was evaluated in terms of maximum interincisal distance (MID) 1 and 5 days after surgery. Pain was evaluated on the basis of reported analgesic use 1 and 5 days after surgery. RESULTS: Among group I subjects, mean day 1 MID did not differ significantly (P > .05) from mean presurgery MID, whereas mean day 1 MID in groups II, III, and IV was significantly lower than before surgery. In groups II, III, and IV, mean day 5 MID remained lower than before surgery. The proportion of group I patients using analgesics was significantly lower on both days 1 and 5 than the proportion of patients using analgesics in groups II, III, and IV. In all groups, the proportion of patients using analgesics dropped significantly between days 1 and 5. CONCLUSION: Trismus is less severe after simple (forceps-only, grade I) extractions than after surgical extractions (grades II to IV). However, trismus severity after surgical extraction does not depend on difficulty of surgery. Pain, as revealed by reported analgesic use, is likewise less severe after simple extractions. Regardless of extraction type, pain declines between days 1 and 5 postsurgery.

Adolescent↗
PubMed1992

Modified use of a dynamic bite opener--treatment and prevention of trismus in a child with head and neck cancer: a case report.

Trismus may be a complication arising during or after treatment of patients with head and neck cancer. Treatment of trismus is difficult, making prevention very important. To prevent and treat trismus in a patient with a nasopharyngeal tumor, the Contract-Relax-Antagonist-Contract (CRAC) technique was applied, with the aid of a custom-made dynamic bite opener (DBO). The CRAC technique in combination with the DBO, as a therapy/prevention program for trismus, is not referred to in the literature. The combination of CRAC and DBO appeared to be a gentle and effective method well tolerated by the patient.

Adolescent↗
PubMed1999

Congenital trismus secondary to masseteric fibrous bands: endoscopically assisted exploration.

The authors present an 18-month-old female infant with congenital trismus. Computed tomography and magnetic resonance imaging were not helpful in determining the cause. A surgical endoscope was used to explore her temporomandibular joints and temporal fossae, thus avoiding the morbidity of a bicoronal incision. The cause was bilateral fibrous bands on the anterior border of the masseter muscles. Incision of these fibrous bands led to relief of the trismus. This finding is consistent with a previously described variant of the Hect-Beals-Wilson trismus-pseudocamptodactyly syndrome. This patient, however, had no evidence of the autosomal dominant inheritance pattern nor did she exhibit pseudocamptodactyly, both of which are generally ascribed to this syndrome. Unfortunately the trismus recurred 3 months postoperatively.

Abnormalities, Multiple↗
PubMed2004

Congenital trismus secondary to masseteric fibrous bands: a 7-year follow-up report as an approach to management.

A 7-year prospective follow-up report, which was previously presented in this journal as an initial pediatric case report, is presented as an approach to management of congenital trismus secondary to masseteric fibrous bands. Adams and Rees discussed management, including endoscopic exploration at 18 months of age with early recurrence of trismus. Under the care of the same plastic surgeon and his team, the progress of this patient over 7 years has given us an insight into management. The cause of trismus is not fully elucidated, but the condition can result in compromised caloric intake, speech development, facial appearance, dental care, and oral hygiene. The decreased oral opening may be secondary to shortening of the muscles of mastication, which may cause tension moulding and distortion of the coronoid process; yet, there is no consensus on the optimal management of temporomandibular joint trismus and all its causes. The patient presented in this report, now aged 7 years, has proceeded through to open surgery on two occasions yet, regrettably, has persistently tight masseter muscles and only 8 mm of jaw opening.

Endoscopy↗
PubMed2005

A non-tooth-borne mouth-opening device for postoperative rehabilitation after surgical release of trismus.

BACKGROUND: The treatment of severe trismus requires a combination of surgical release and postoperative rehabilitation; the latter is essential for preventing a relapse due to postoperative inactivity and scarring. Mouth-opening devices for this purpose are placed between or fixed to the teeth to keep the dental arches apart; but patients suffering from severe trismus often present with partially or totally edentulous arches, decayed teeth, or periodontitis, which do not allow for the use of such devices. METHODS: In this article, a new mouth-opening device is described. It applies force to two intraoral screws placed in the vestibulum of the maxillary and mandibular bones. It can be used in patients with poor dental conditions and allows rehabilitation to start immediately after trismus release. RESULT: A case is presented. The interalveolar distance was improved from 5 mm to 45 mm and maintained at 6-month follow-up. CONCLUSION: Our non-tooth-borne mouth opening device is useful for postoperative rehabilitation after surgical release of trismus.

Bone Screws↗
PubMed2002

Trismus in a 6 year old child: a manifestation of leukemia?

Trismus is a firm closing of the jaw due to tonic spasm of the muscles of mastication from disease or the motor branch of the trigeminal nerve. Trismus may be produced by a variety of reasons such as dental abscess, trauma, following mandibular block with local anesthesia, as a result of radiation to the facial muscles, and patients after chemotherapy. A case of a referral of a six-year-old boy to a dentist from an ENT due to severe limitation in jaw opening is presented. Intraoral examination and panoramic radiograph demonstrated no signs of infection and/or other pathology. After a diagnosis of trismus was made, due to his icteric appearance, the general fatigue and loss of appetite in the last few days, palpated and sensitive lymph nodes in the submandibular and cervical regions, the child was referred for a complete blood count and sedimentation rate. The laboratory and clinical findings resulted in the diagnosis of acute lymphoblastic leukemia (ALL). Dental and oral manifestations of ALL are discussed, and the trismus may be explained by an intensive infiltration of leukemic cells into the deep portion of the contracting muscles of the face. This case emphasizes the importance of physical examination and independent judgement made by dentists, even when patients are referred to them by other members of the medical communities.

Blood Cell Count↗
PubMed2000

Effects of reduced mouth opening capacity (trismus) on pulmonary function.

In this study, pulmonary function test data were obtained from 15 healthy volunteers and 15 patients with slightly impaired ventilation during both normal and maximally reduced opening of the mouth (trismus, intercuspal position). The aim of the study was to examine the effects of complete trismus on pulmonary function using objective and subjective parameters. In maximally reduced mouth opening, both groups showed an impairment of all subjective and objective pulmonary function test data. In healthy volunteers, the significant changes in test data (P<0.05) stimulated mild to moderate pulmonary impairment, whereas patients with an already impaired pulmonary function showed a marked deterioration of their initial respiratory condition. The results of the subjective and objective parameters examined indicate that an intercuspal position (trismus) further aggravates pulmonary functional impairment. Complete trismus can be considered a risk factor to pulmonary function in patients using mouth breathing as a primary or supportive mode of respiration.

Adult↗
PubMed2006

The use of methylprednisolone versus diclofenac in the treatment of inflammation and trismus after surgical removal of lower third molars.

OBJECTIVE: To compare the efficacy of methylprednisolone (corticoid) versus diclofenac (nonsteroidal anti-inflammatory--NSAID) in the treatment of inflammation and trismus after the surgical removal of lower third molars. STUDY DESIGN: Prospective study on 73 patients for the surgical removal of their lower third molars. These patients were separated in two groups at random: the diclofenac group and the methylprednisolone group. A record card was filled in with preoperative and postoperative epidemiological and clinic data about inflammation and trismus (three facial measures and mouth opening). In order to make a broad study of data, BMDP program was used for statistics. RESULTS: 24 hours after surgery, patients in the diclofenac group showed a more severe inflammation in one of the facial measurements (<0.05). Trismus was very similar in both groups. CONCLUSIONS: There were no differences in trismus depending on the antiinflammatory used. Patients in the corticoid group showed less inflammation but the difference was not as important as to justify their use.

Anti-Inflammatory Agents↗
PubMed1989

[Chronic trismus in the severe skeletal Class III cases].

In general, patients who have trismus as chief complaint often have acute symptoms, but limited number of these patients have chronic trismus. We studied 51 patients (mean age; 18y 4n) with severe skeletal class III (less than ANB less than or equal to O), who need surgical treatment. Three types were classified according to the movement of the mandibular head at the maximum mouth opening at their first visit. A-type; the mandibular head hardly move. B-type; it dose not move beyond articular eminence. C-type; it moves beyond articular eminence. These classifications were applied to the both sides of the mandibular head in the 51 patients to divide into 5 types (Type AA, Type AB, Type BB, Type BC, Type CC). Those patients were analyzed according to these five types. The results obtained were as follows; 1) Seventy-three percent of all the cases were female in this study. Sixty-five percent of both the sexes had chronic trismus without having subjective symptoms on the mandibular joints in their daily lives. Type AA, AB, BB, and BC accounted for 12%, 6%, 31%, and 16% respectively. 2) There were fewer contacts in the upper posterior antagonist teeth in AA and AB; particularly at 5. In all the cases of Type CC, contacts with the antagonist tooth 5 were seen. 3) As a conclusion, movement of the mandibular head in the patients with trismus are found to have a characteristic limitation at the maximum mouth opening and the stress points in the occlusal contacts at the centric occlusion to be the posterior area.

Adolescent↗