Management of severe trismus with protocol of forceful mouth opening, under local anesthesia and sedation combined with physiotherapy

Abstract

Back ground :Trismus is pathological condition of muscle of mastication ; masseter , temporalis and medial and lateral pterygoid muscles that may affect patients who have undergone dental procedures ,radiotherapy , surgery and may be manifestation of psychiatric illness .trismus may affect oral hygiene , various dental procedures speaking , swallowing and may predispose for malnutrition. The aim of current study was to evaluate the effectiveness of forceful mouth opening under LA with sedation that accompanied by physiotherapy for patient suffering from severe trismus.Patients and methods: Eight patients “. 6 women and 2 men “ were included in the study who meet the inclusion criteria. All patients presented with limited mouth opening with the maximal interincisal distance (MID) of less than 35mm which is used as a cutoff point to determine trismus . Forceful mouth opening with screw type mouth gag in the clinic under local anesthesia and sedation with subsequent regular exercise at definite protocol that practice at home . Results : Patients attend the clinic with trismus that range between 5-16 mm. Frequent follow up of the patient for about 10 weeks demonstrate improvement of MID that range 24-37mm with the mean of “30.875”Conclusion: Forceful mouth opening under LA with sedation for patients suffering from severe trismus ,in conjunction with physical therapy. Is safe and effective in increasing MID