Below are some of the conditions associated with trismus: Trismus may also be iatrogenic, resulting from prescribed interventions and treatments. Others have outlined the causes into broad categories, such as infectious, traumatic, and neoplastic sources. Some authors classify trismus according to the involvement of the temporomandibular junction (TMJ) in intraarticular and extraarticular etiologies. Multiple conditions can result in trismus. Furthermore, surgical procedures to treat head and neck cancer can scar the mastication muscles and restrict mandibular opening. The risk of trismus goes up when the medial pterygoid muscle is in the radiation zone. The temporomandibular joint or the mastication muscles can experience fibrosis because of radiotherapy, leading to trismus. According to recent studies, it develops in 38% to 42% of head and neck cancer patients. Trismus is a common side effect of head and neck cancer and its treatment. Trismus As a Complication Of Head and Neck Cancer Treatment If a patient presents with any of the following five signs and symptoms, radiographs and referral to a senior clinician must be considered. For this reason, a specialist TMD clinic has developed a checklist to identify trismus cases with atypical features. For example, a case of a 62-year-old patient presenting with severe trismus and TMJ pain who was misdiagnosed as having a TMD and underwent treatment but was found to have adenocarcinoma of the temporal region a year later. Cases of misdiagnosis of trismus as TMD leading to delayed diagnosis of malignancy have been described in the literature. Trismus rarely presents as the primary sign of malignancy, but it should not be ruled out. However, although less common, trismus may also be caused by malignancy. Patients presenting with limited mouth opening and pain in the pre-auricular area are likely to be diagnosed as having a TMD. Examples of infections from non-odontogenic sources that may trigger trismus include tonsillitis, parotid abscess, tetanus, meningitis, and brain abscess. From the infections of dental origin, pericoronitis is more associated with trismus. These infections can extend into the head and neck spaces and result in life-threatening complications, like mediastinitis and cervical cellulitis. Trismus As a Complication of Dental Infectionĭental infection must be suspected in patients presenting with acute trismus, as severe dental infections involving the masticatory muscles often cause trismus. Myofascial pain and disc displacement without reduction are two common types of TMD that may cause trismus. Therefore, many patients reporting limited mouth opening are likely to have a TMD. TMDs typically cause facial and preauricular pain, functional noises in the TMJ, and limitation in mandibular movement. Temporomandibular disorders refer to the dysfunction and pain of the temporomandibular joint (TMJ) and muscles of the mastication. Trismus As a sign Of Temporomandibular Disorders (TMD) Although rare, fractures of the zygomatic arch and zygomaticomaxillary complex have the potential to cause trismus as they impede the movement of the coronoid process. Trismus As a complication of Trauma to the Face and Mandibleįractures, mainly mandibular, may result in limited mouth opening. Such complications result from the inflammatory response to surgical trauma and are classically short-term. Pain, trismus, and swelling are common complications of the surgical extraction of mandibular third molars. Trismus As a Complication of Dental Extractions Trismus after two to three days of the injection is most likely caused by a needle track infection. Injury to the inferior alveolar artery or vein may lead to hematoma in the pterygomandibular space, resulting in trismus. Trismus may also arise when an intramuscular hematoma occurs. When the affected muscle stretches, it triggers pain, causing its immediate reflex contraction and mandibular opening limitation. During the administration of this block, the masticatory muscles can be accidentally penetrated, mainly the medial pterygoid muscle, resulting in pain-related trismus. Trismus is a possible complication of the inferior alveolar nerve block (IANB). Trismus As a Complication of Local Anesthesia Ĭhronic trismus may arise from temporomandibular disorders, neoplasia, surgery, radiotherapy in the head and neck for managing cancer, local infections, and connective tissue disorders like lupus erythematosus. Severe trauma usually causes chronic trismus. Acute trismus from iatrogenic causes tends to be self-limiting. Examples of iatrogenic trauma include third molar extraction and intramuscular administration of anesthesia. Acute trismus may be caused by facial, mandibular, or iatrogenic trauma.
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