inability to open mouth and treatment

1. sinaiuniversity.net
Dr SaraZaki
BDs. MDs. DDs.
Lecturer of Removable Prosthodontics

2. @Sinaiunieg www.su.edu.eginfo@su.edu.eg
Trismus
(Limited mandibular movement)

3. Etiology Of Trismus
 1) Acute Factors
I- Local trauma; as inferior alveolar nerve block leading to muscle inflammation
Trauma due accident or post surgical effect
II-Infection ptergo-mand& later. Pharyng. spaces, pericoronitis following oral
surgery
III- Psychological
IV- drug toxicity (e.g Halothane )

4. 2) Chronic Factors
I- TMJ dysfunction : poor joint architecture or malposition of the disc and
muscle splinting restrict motion )
II-Rheumatoid arthritis
III- Pathological process the condyle as ; osteoma.zygoma., cysts. coronoid or
condyle over growth
IV- ankylosis : extra or intracapsular
V- sclerodrma
VI- systemic diseases e,g Epilepsy or Brain tumor

5. 3) Treatment Related Factors
I- Radiation therapy
II- Surgical treatment
III- orthognathic surgery.

6. Evaluation of Trismus
 1- case history
 2- oral mechanism emanations
 3- clinical evaluation of swallowing and pain results

7. Treatment of Trismus
 1- medical
 2- surgical
 3- physical

8. Medical treatment
• Antibiotics : if the infection is the cause , it is the treatment of choice
• Anti- inflammatory : Arthritis inflammation of the joint can be treated with anti-
inflammatory agents which relief pain and result in some improvement in motion
• Muscle relaxants : may help in acute cases of limited mandibular movement

9. Surgical treatment
 Surgery is the treatment of choice for removal of tumors , cysts or foreign
bodies
 Surgery may also be indicated in TMJ ankylosis and sceloderma after more
conservative therapy has failed

10. Physical treatment
 Several methods to increase inter arch space and counteract trismus including
 1- exercise
 2- Mechanical devices
 3- Hot application

11. 1- exercise
 Indication :
Helpful during
A-Radiation therapy
B-Scleroderma patients
 Techniques
 Opening and closing 20 times for 3 to 4 times daily
 8-10 lateral movements
 Chewing gum ???? No therapeutic effect ??? Why

12. Trismus devices
 Indications :
 1- adhesion and ankylosis
 2- arthritis
 3- disuse atrophy
 4- facial Muscle Disorders
 5- radiation therapy
 6- joint replacement
 7- trismus
 8- trauma and condylar fracture

13. Types of mechanical devices
 I- Simple devices
 II- dynamic bite opener

14. Simple devices
 1- wooden clothespin : inserted between the arches while the patient applies
gradual pressure

15. Simple device
 Tapered threaded acrylic screw placed and turned between teeth
 Applied several time daily

16. Simple device
Tongue depressors (blade)
Lubricated with petroleum jelly and
placed between the arches for 1 minute to increase opening
Additional depressors can be added
one at time

17. Dynamic bite opener
 I- old devices
A- dynamic opening device : consist of a steel frame
work attached to maxillary and mandibular stents

18. Dynamic bite opener (old device)
 B- inflatable bite opener
Consist of maxillary and mandibular stents with
An inflatable pediatric blood pressure with
rubber bulb and tubing

19. Dynamic bite opener (old device)
 C- intra-oral prosthesis with inter-arch spring
 Used with both dentulous and edentulous patients

20. Dynamic bite opener (recent device)
 Springs
 Device work with pump action
 Mechanical stretch device
 Most recent is computer controlled continuous passive motion device

21. Computer controlled continuous passive motion
device (CPM)

22. Facial flex (spring)

23. Flex jaw exerciser

24. THANK YOU
Dr, sara zaki
BDs. MDs. DDs.
Lecturer Removable Prosthodontics
Foranyquestionsfeel free
tocontactme bymail
Sara.zaki@su.edu.eg