Trismus

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Luke Rusowicz-Orazem, B.S.

Overview

Trismus (also known as lock jaw) is the inability to normally open the mouth due to one of many causes.

Causes

Life Threatening Causes

• Acute osteomyelitis
• Coral snake poisoning 
• Dental tissue neoplasm 
• Fibrosis
• Funnel web spider poisoning 
• Horseshoe crab poisoning

Common Causes

• Acute osteomyelitis
• Ankylosis
• Condylar fracture
• Gaucher disease
• Local anesthesia
• Pericoronitis
• Inflammation of mastication muscles
• Peritonsillar abscess
• Radiation therapy
• Temporomandibular joint disorder
• Tetanus

Causes by Organ System

Cardiovascular	Ludwig angina, Stroke
Chemical/Poisoning	Coral snake poisoning , Funnel web spider poisoning , Horseshoe crab poisoning
Dental	Broken jaw, Coronoid hyperplasia, Damage to the trigeminal nerve, Dental caries , Dental tissue neoplasm , Drug associated dyskinesia, Fractured mandibular condyle , Idiopathic orofacial dystonia, Impacted wisdom tooth, Jaw ankylosis, Jaw pain, Odontogenic infection, Pericoronitis , Peritonsillar abscess, Post surgical edema, Prolonged dental treatment , Quinsy, Submasseteric abscess, Submucous fibrosis, Supraglottic laryngeal cancer , Temporomandibular joint disorder , Tm joint disorder, Tonsillitis, Trismus pseudocamptodactyly syndrome
Dermatologic	Epidermolysis bullosa
Drug Side Effect	Acetaminophen, Amphetamine, Drug associated dyskinesia, Local anesthesia, Mdma, Perphenazine, Strychnine
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	Oral submucous fibrosis
Genetic	Crisponi syndrome, Gaucher disease , Iida-kannari syndrome , Trismus pseudocamptodactyly syndrome
Hematologic	Hematoma of medial pterygoid, Hypocalcemia, Stroke
Iatrogenic	Local anesthesia, Malignant hyperpyrexia, Post surgical edema, Prolonged dental treatment , Radiation fibrosis, Radiation therapy , Surgery
Infectious Disease	Acute parotitis, Clostridium tetani, Infection, Ludwig angina, Mumps, Myositis, Odontogenic infection, Pericoronitis , Peritonsillar abscess, Quinsy, Rabies, Submasseteric abscess, Tetanus, Tonsillitis, Trichinella spiralis, Trichiniasis
Musculoskeletal/Orthopedic	Acute osteomyelitis, Ankylosis , Arthrogryposis , Fibrosis , Iida-kannari syndrome , Inflammation of the muscles of mastication, Mastication muscle inflammation, Medial pterygoid, Myofascial pain, Myositis, Osteoarthritis, Osteophyte formation, Tetanus, Tm joint disorder
Neurologic	Acute osteomyelitis, Facial neuralgia, Facial pain, Facial trauma, Neuroleptics
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	Coronoid hyperplasia, Dental tissue neoplasm , Local malignancy, Mucoepidermoid carcinoma , Supraglottic laryngeal cancer , Tumors
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	Hysteria, Malingering, Seizure disorder
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	Arthritis, Fibrosis , Hypocalcemia, Jaw ankylosis, Osteoarthritis, Osteophyte formation, Psoriatic arthritis, Radiation fibrosis, Rheumatoid arthritis, Scleroderma, Septic arthritis, Submucous fibrosis, Systemic lupus erythematosus, Systemic sclerosis, Traumatic synovitis
Sexual	No underlying causes
Trauma	Broken jaw, Burns, Condylar fracture , Damage to the trigeminal nerve, Dental caries , Facial trauma, Jaw pain, Needle prick, Trauma
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• Acetaminophen
• Acute parotitis
• Acute osteomyelitis
• Amphetamine
• Ankylosis 
• Arthritis
• Arthrogryposis
• Broken jaw
• Burns
• Clostridium tetani
• Condylar fracture
• Coral snake poisoning 
• Coronoid hyperplasia
• Crisponi syndrome
• Damage to the trigeminal nerve
• Dental caries 
• Dental tissue neoplasm 
• Drug associated dyskinesia
• Epidermolysis bullosa
• Facial neuralgia
• Facial pain
• Facial trauma
• Fibrosis
• Fractured mandibular condyle
• Funnel web spider poisoning 
• Gaucher disease 
• Hematoma of medial pterygoid
• Horseshoe crab poisoning
• Hypocalcemia
• Hysteria
• Idiopathic orofacial dystonia
• Iida-kannari syndrome 
• Impacted wisdom tooth
• Infection
• Jaw ankylosis
• Jaw pain
• Local anesthesia
• Local malignancy
• Ludwig angina
• Malignant hyperpyrexia
• Malingering
• Mastication muscle inflammation
• Mdma
• Medial pterygoid
• Mucoepidermoid carcinoma 
• Mumps
• Myofascial pain
• Myositis
• Neuroleptics
• Odontogenic infection
• Oral submucous fibrosis
• Osteoarthritis
• Osteophyte formation
• Pericoronitis
• Peritonsillar abscess
• Perphenazine
• Post surgical edema
• Prolonged dental treatment
• Psoriatic arthritis
• Quinsy
• Rabies
• Radiation fibrosis
• Radiation therapy 
• Rheumatoid arthritis
• Scleroderma
• Seizure disorder
• Septic arthritis
• Stroke
• Strychnine 
• Submasseteric abscess
• Submucous fibrosis
• Supraglottic laryngeal cancer 
• Surgery
• Systemic lupus erythematosus
• Systemic sclerosis
• Temporomandibular joint disorder 
• Tetanus
• Tonsillitis
• Trauma
• Traumatic synovitis
• Trichinella spiralis
• Trichiniasis
• Trismus pseudocamptodactyly syndrome
• Tumors

Treatment

Treatment requires treating the underlying condition. Additionally, control of symptoms with pain medications (NSAIDs), muscle relaxants, and warm compresses may be used. In the management of trismus, therapeutic approaches are tailored to address the underlying cause. The primary treatment strategy involves symptomatic relief. Common interventions during the acute phase include the application of **heat therapy**, the use of analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants. Heat therapy typically involves the placement of moist, heated towels on the affected area for 15 to 20 minutes each hour. For pain relief, aspirin is often deemed adequate. In cases where muscle relaxation is necessary, a benzodiazepine like diazepam may be prescribed, with dosages ranging from 2.5 to 5 milligrams taken thrice daily. Additionally, healthcare providers may recommend a soft diet to patients for the duration of the condition.

References

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