Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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CLINICAL STUDY ON THE ETIOLOGY, DIFFERENTIAL DIAGNOSIS AND TREATMENT OF TRISMUS

개구장애 환자의 병인, 감별진단 및 치료방식에 대한 임상연구

  • Kang, Hee-Jea (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University) ;
  • Hwang, Dae-Seok (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University) ;
  • Kim, Yong-Deok (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University) ;
  • Shin, Sang-Hun (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University) ;
  • Kim, Uk-Kyu (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University) ;
  • Kim, Jong-Ryoul (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University) ;
  • Chung, In-Kyo (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University)
  • 강희제 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 황대석 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 김용덕 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 신상훈 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 김욱규 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 김종렬 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 정인교 (부산대학교 치과대학 구강악안면외과학교실)
  • Published : 2006.12.31
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Abstract

Trismus is a common problem to most people experiencing at once in his or her life and to most dental practitioners experiencing frequently. It has a number of potential causes which are single factor or complex factors. Its treatment will depend on the cause. The purpose of this study was to discuss the causes of trismus condition and the various treatments available. This study was made by reviewing of collected data from 86 patients complained of trismus among patients who were diagnosed by TMD, tumor, infection including tetanus, soft tissue anomalies, bony fracture and ankylosis from Jan 2002 to Dec 2004 on department of oral and maxillofacial surgery at Pusan National University Hospital, South Korea. The clinical reviews regarding chief complaints, clinical characteristics, diagnostic examination, treatments and the results on the patients were given as follows. 1. The etiology of trismus commonly were derived from temporomandibular joint(TMJ) disorder, TMJ ankylosis, TMJ tumor, odontogenic maxillofacial infection, mandibular condylar fracture, tetanus. 2. The chief complaints of trismus patients were progressive mouth opening limitation, TMJ pain, malocclusion, facial asymmetry, retrognathic state. 3. Especially, for the differential diagnosis between the fibrous ankylosis and true bony ankylosis, computed tomogram (CT) was useful. Surgical gap arthroplasty on bony ankylosis patients was applied and the gain of mouth opening after operation was average 35.8 mm during 19 months. 4. The tetanus, rarely, also induced the trismus with the range of mouth opening less than 10 mm. The average serum level of tetanus anti-toxin was 0.02-0.04 IU/mL. The limitation of mouth opening was improved into average 38 mm on 4 weeks after injection of 10,000 units of tetanus immune globulin. 5. In the treatment of osteochondroma, TMD, odontogenic infection and fracture, and the others inducing trismus, to obtian the maximum result and decreased inadequate time and effort, it is important to finding the causes from the exact clinical examination and diagnosis.

Keywords

References

  1. Tveteras K, Kristensen S: The aetiology and pathogenesis of trismus. Clinical Otolaryngol 1986;11:383-387 https://doi.org/10.1111/j.1365-2273.1986.tb00141.x
  2. Rowe NL: ankylosis of the temoporomandibular joint. J Roy Coll Edin 1982;27:67-81
  3. Shah K: Trismus: bizarre finding. Br J Oral Maxillofacial Surg 2000;38:397-398
  4. Nelson SJ, Nowlin TP, Boeselt BJ: Consideration of linear and angular values of maximum mandibular opening. Compend Contin Educ Dent 1992;13:362-363
  5. Dworkin SF, Huggins KH, LeResche L, et al: Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls. J Am Dent Assoc 1990;120:273-281 https://doi.org/10.14219/jada.archive.1990.0043
  6. Medra AMM: Follow up of mandibular constochondral grafts after release of ankylosis of the temoporomandibular joints. Br J Oral Maxillfac Surg 2005;43; 118-122 https://doi.org/10.1016/j.bjoms.2004.05.004
  7. Dijkstra PU, Kalk WW, Roodenburg JLN: Trismus in head and neck oncology : a systemic review. Oral Oncol 2004;40:879-889 https://doi.org/10.1016/j.oraloncology.2004.04.003
  8. Ozayar E, Cengiz M, Gurkaynak M, et al.: Trismus as a presenting symptom in nasopharyngeal carcinoma. Radiother Oncol 2005;77(1);73-76 https://doi.org/10.1016/j.radonc.2005.07.006
  9. Chua DT, Lo c, Yuen J, et al.: A pilot study of pentoxifylline in the treatment of radiaton-induced trismus. Am J Clin Oncol 2001;23;366-369
  10. Bertrand J, Luc B, Philippe M, et al.: Anterior mandibular osteotomy for tumor extirpation: a critical evaluation. Head Neck 2000;22;323-327 https://doi.org/10.1002/1097-0347(200007)22:4<323::AID-HED2>3.0.CO;2-8
  11. Luyk JH, Steinberg B: Aetiology and diagnosis of clinically evident jaw trismus. Austr Dent J 1990;35;523-529 https://doi.org/10.1111/j.1834-7819.1990.tb04684.x
  12. Marien M: Trismus : Causes, differntial diagnosis, and treatment. Gen Dent 1997;45;350-355
  13. Okeson JP: Orofacial pain : guidelines for assessment, diagnosis, and, management, ed 3, Chicago, 1996, Quintessence p45-52
  14. Minakuch H, Kuboki T, Matsuka Y, et al: Randomized controlled evaluation of nonsurgical treatments for temporomandibular joint anterior disk displacement without reduction. J Dent Res 2001;80:924 https://doi.org/10.1177/00220345010800031501
  15. Sato S, Kawamura H, Motegi K: Management of nonreducing temporomandibular joint disk displacement. Evaluation of three treatments. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:384 https://doi.org/10.1016/S1079-2104(05)80328-2
  16. Sawhney CP: Bony ankylosis of the temporomadibular joint. Follow up of 70 Patients treatment with arthropalsty and acrylic spacer interposition. Plast Reconstr Surg 1986;77:29-38 https://doi.org/10.1097/00006534-198601000-00006
  17. Krentz RW, Yamada R: Posttraumatic extracapsular temporomandibular bony ankylosis between the coronoid process and base of skull. Oral Surg Oral Med Oral Pathol 1985;60;577-580 https://doi.org/10.1016/0030-4220(85)90354-8
  18. Stutville OH, Larfranchi RP: Surgical reconstruction of the temporomandibular joint. Am J Surg 1955;90;940-950 https://doi.org/10.1016/0002-9610(55)90726-1
  19. Taher AAY: Treatment of TMJ ankylosis. Plast Reconstr Surg 1994;93;44 https://doi.org/10.1097/00006534-199401000-00007
  20. Bifano CA, Hubbard G, Ehler WJ: Total reconstruction of the temporomandibular joint with cryogenically preserved allograft mandibular condyle, meniscus, and fossa in the adult goat. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80;267-272 https://doi.org/10.1016/S1079-2104(05)80381-6
  21. Kermer C, Rasse M, Undt G, et al: Cartilaginous exostosis of the mandible. Int J Oral Maxillofac Surg 1996;25:373 https://doi.org/10.1016/S0901-5027(06)80034-2
  22. Kurita K, Ogi N, Echiverre NV, et al: Osteochondroma of the mandibular condyle. A case report. Int J Oral Maxillofac Surg 1999;28:380 https://doi.org/10.1016/S0901-5027(99)80088-5
  23. Ward BB, S. Pires CA, Feinberg SE: Osteochondromas of the Mandible: Case Reports and Rationale for Treatment. J Oral Maxillofac Surg 2005;63:1039-1044 https://doi.org/10.1016/j.joms.2005.03.022
  24. Hooder SC, Rees JIS, Oliver TB, et al.: SPECT bone scintigraphy in the diagnosis and management of mandibular hyperplasia. Br J Oral Maxillofac Surg 2000;38:87-93 https://doi.org/10.1054/bjom.1999.0209
  25. Obwegeser HL, Makek MS. Hemimandibularhyperplasia-hemimandibular elongation. J MaxFac Surg 1986;14:183-208
  26. Ariji Y, Gotoh M, Kimura Y, et al.: Odontogenic infection pathway to the submandi- bular space: imaging assessment. Int J Oral Maxillofac Surg 2002;31;165-169 https://doi.org/10.1054/ijom.2001.0190
  27. Hardin CW, Harnsberger HR, Osborn AG, et al.: Infection and tumor of the masticator space: CT evaluation. Radiology 1985;157:413-7 https://doi.org/10.1148/radiology.157.2.4048449
  28. Ohshima A, Ariji Y, Goto M, et al.: Anatomical considerations for the spread of odontogenic infection originating from the pericoronitis of impacted mandibular third molar: Computed tomographic analyses. Oral Surg Oral Med Oral Path Oral Rad Endod 2004;98;589-597 https://doi.org/10.1016/j.tripleo.2004.07.012
  29. Chacon GE, Dawson KG, Robert WT, et al: A Comparative Study of 2 ImagingTechniques for the Diagnosis of Condylar Fractures in Children. J Oral Maxillofac Surg 2003;61:668-672 https://doi.org/10.1053/joms.2003.50134
  30. Kermer CH, Undt G, Rasse M: Surgical reduction and fixation of intracapsular condylar fractures. A follow up study. Int J Oral Maxillofac Surg 1998;27;191-194 https://doi.org/10.1016/S0901-5027(98)80008-8
  31. Hlawitschka M, Loukota R, Eckelt U: Functional and radiological results of open and closed treatment of intracapsular (diacapitular) condylar fractures of the mandible. Int J Oral Maxillofac Surg 2005;34;597-604 https://doi.org/10.1016/j.ijom.2005.02.004
  32. Smets MH, Damme PAV, Stoelinga PJW: Non-surgical treatment of condylar fractures in adults: a retrospective analysis. J Craniomaxillofac Surg 2003;31;162-167 https://doi.org/10.1016/S1010-5182(03)00025-8
  33. Kristensen S, Tveteras K: Trismus and carcinoma of the tonsil Arch Otolarinolaryngol 1984;241;141-143
  34. Weinsteisn L: Current concetps of tetanus. New Eng J Med 1973;289;1293-1296 https://doi.org/10.1056/NEJM197312132892408
  35. Alfrey DD, Rauscher LA: Tetanus a review Crit care Med 1979;7;176-181 https://doi.org/10.1097/00003246-197904000-00007
  36. Hahn BJ, Erogul M, Sinert R: Case report of tetanus in an immunized, healthy adult and no point of entry. DO J Emerg Med 2004;27;257-260 https://doi.org/10.1016/j.jemermed.2004.03.015
  37. Blake PA, Feldman TM, Buchanan TM, et al.: Serologic therapy of tetanus in the United States, 1965-1971. JAMA 1976;235;42-44 https://doi.org/10.1001/jama.1976.03260270028022
  38. Ahmadsyah I, Salim A: Treatment of tetanus: an open study to compare the efficacy of procaine penicillin and metronidazole. Br Med J (Clin Res Ed) 1985;291;648-651 https://doi.org/10.1136/bmj.291.6496.648
  39. Ichimura K, Tanaka T: Trismus in patients with malignant tumours in the head and neck. J Laryngol Otol 1993;107;1017-1020
  40. Zubizarreta PA, D'Antonio G, Raslawski E, et al.: Sackmann-Muriel, Nasopharyngeal carcinoma in childhood and adolescence: a singleinstitution experience with combined therapy. Cancer 2000;89;690-695 https://doi.org/10.1002/1097-0142(20000801)89:3<690::AID-CNCR26>3.0.CO;2-S
  41. Miller FR, Wanamaker JR, Lavertu P: Magnetic resonance imaging and the management of parapharyngeal space tumors. Head Neck 1996;18;67-77 https://doi.org/10.1002/(SICI)1097-0347(199601/02)18:1<67::AID-HED9>3.0.CO;2-X
  42. Goldstein M, Maxymiw WG, Cummings BJ et al.: The effects of antitumor irradiation on mandibular opening and mobility: a prospective study of 58 patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88;365-373 https://doi.org/10.1016/S1079-2104(99)70044-2
  43. Spinazze RP, Heffez LB, Bays RA: Chronic, progressive limitation of mouth opening. J Oral Maxillofac 1998;56:1178-1186 https://doi.org/10.1016/S0278-2391(98)90767-4
  44. Mano T, Ueyama Y, Koyama T, et al.: Trismus due to bilateral coronoid hyperplasia in a child: Case report. J Oral Maxillofac Surg 2005;63;399-401 https://doi.org/10.1016/j.joms.2004.07.018
  45. Kadyan V, Clairmont AC, Engle M, et al.: Severe trismus as a complication of cerebrovascular accident: A case report. Arch Phys Med Reh 2005;86;594-595 https://doi.org/10.1016/j.apmr.2004.06.061
  46. Von Arx DP: Long standing trismus as the initial presentation of acute catatonic schizophrenia. Br J Oral Maxillofac Surg 1989;27;22-26 https://doi.org/10.1016/0266-4356(89)90122-8
  47. Wei FC, Chang YM, Kildal M, et al.: Bilateral small radial forearm flaps for the reconstruction of buccal mucosa after surgical release of submucosal fibrosis: a new, reliable approach. Plast Reconstr Surg 2001;107;1679-1683 https://doi.org/10.1097/00006534-200106000-00007
  48. Irvine GH, Rowe NL: Hysterical trismus: a diagnostic problem. Br J Oral Maxillofac Surg 1984;22;225-229 https://doi.org/10.1016/0266-4356(84)90102-5