Trismus
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The document discusses the causes (etiology) and treatment of trismus, which is limited opening of the mandible. It describes acute and chronic factors that can cause trismus, including local trauma, infection, TMJ dysfunction, and diseases like rheumatoid arthritis. Evaluation involves case history and clinical examination. Treatment includes medical approaches like antibiotics and anti-inflammatories, surgical interventions for certain conditions, and physical therapy techniques like exercises and mechanical devices to gradually increase mandibular range of motion. Recent dynamic bite opener devices use springs or computer-controlled mechanisms to passively stretch the jaw.
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Trismus
- 1. sinaiuniversity.net Dr SaraZaki BDs. MDs. DDs. Lecturer of Removable Prosthodontics
- 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)
- 24. THANK YOU Dr, sara zaki BDs. MDs. DDs. Lecturer Removable Prosthodontics Foranyquestionsfeel free tocontactme bymail Sara.zaki@su.edu.eg