An unusual case of trismus JO/III hf. Ale,rtmdrr, I1.D.S. Richmd, DEPARTMENT

OF ORAI.

.4ND

Itr.

MXILLOI

A(‘l41.

SURGERl

. \lf.I)I(

.Al t 01 1.1 (IL

Of

\IRC~l~l~\

SC.HOC)l. OF DEKllSTR’r’

Described is a case in which a patient suffered multiple facial injuries resulting In significant trismus. Many extracapsular factors have been reported to result in trismus. Most common are those involving the coronoid process and fibrous tissue adhesions of associated structures. Thts case Involves a situation in which multiple foreign-body fragments led to this patient’s being unable to open his mouth adequately

T

rismus

has generally

open

the mouth.

grees

of this limited

speak of trismua refer

opening.”

with

authors

t’rom either

sion will

be limited

4 majority

bony

“. A, !‘. ”

coronoid

process

causes

I‘ectious

processes.” MPD and

I 5) toreign rounding

abnormalities

(2)

process

include to adjacent

impingement

resulting

arch,’ f’rom

procedures.‘.

should

be mentioned. (2)

syndrome, adjacent bodies

are related

of

the

(3) an cm either

and (4) pseudoankylosis

craniotomy

capsular eluding tication

These

(inability

causes

on the Lq’gomatic

or neoplasia.

a patient

and the discus-

cases of triamus

of the coronoid

process

to temporal

or extracapsular involves

to these causes.

abnormalities.

alructure.‘.

larged plasia

to to

of extracapsular

1 I) true ankylosis c~oronoid

inability

agree that this inability

etiology

of the reported

to open adequately) to coronoid

but, in contrast

persistent

case report

of cxtracapsular

to de-

and Kaban”

process

intracapsular

The following

trismus

as the inability we see varying

Guralnick

as “a chronic.

open the jab .‘* Most open results

practice

as a temporary

to ankvlosis

conditions.

been detined

In dental

hyper-

secondary

‘. “’ Other

cxtra-

namely:

( 1 ) in-

neuromuscular

diseases.

in-

(3) trauma to muscles of masstructures, (4) fractures. and

lodged

in adjacent

spaces

and sur-

tissues.

DIAGNOSIS The diagnostic modalities are well known, but the interpretation can often be confusing and obscured. The hi\tor> findings

is as important of the \jarious

as or more radiographic

important techniques.

at’lcr all the informative data are complete. must rely heavily on his clinical judgment

than the Even

the surgeon in determin-

ing rhc cause and its anatomic location, The I’ollowing cast report illustrates an unusual sitiiLition that resulted in significant trismus for the patient. 418

Volume 17 Number 5

The patient did well postoperatively and. with adjuncti\ e physiotherapy, was able to achieve and maintain an accept-

ableopeningof 36 mm. DISCUSSION

A case of trismus that resulted from the presence of foreign bodies and secondary fibrous adhesions has been presented. I realize that the glass fragments may not have been the sole cause of the patient’s inability to open his mouth and that the multiple traumatic injuries and associated fractures could certainly have contributed to the trismus. The

author

was in resident this

wishes training.

to thank

Dr.

for help

William

0.

Knight.

in the care and treatment

who 01

patient.

REFERENCES I. Allison,

Fig. 2. Multiple

glass

t’ra~nicnts

removed

from

right

rnan-

The

most

dible.

z-ion.

SC\ cral

sipniticant

transos\c‘ous

finding.

mass

seen

(Fig.

I).

Operative

in

patient

thc\ia.

the

acre

in place.

was an irregular

coronoid

notch

of

the

radiopaque

right

mandible

finding

An attempt the

wires

howcvcr.

M;L’I nude

Onl!

to open

pxaly~cl

wax .I i’e~

the mouth

under

millimetcrx

t’orcefully

appropriate

while

general

of additional

opening

ants-

could

bc

obtained. The mandihlc sion.

~lultiplc

adhesions

\~;Is next

approached

arcas 01‘ chronic

\\crc

found

and

rcmo\ed

the coronoid

notch

\\ as Inoted

to extend

Inferior

in the qle

and acliacc’nt ate-si/cd from

&I-resscd. \ iou\ fracture hortlcr

through

granulation

M. L.. Wallace. W. R., and Von Wyl. H.: Coronold Abnormalities Causing Limitation of Mandibular Movcmcnt. J. Oral Surg. 27: 229-233, 1969. 2. Brown. J. B., and Peterson, L. W.: Ankylnala and Trlsmus Resulting From War Wounds Involving the Coronoid Region 01 the Mandible, J. Oral Surg. 4: 2.58-266. 1946. 3. Clark. D. C.: Prolonged Triamus in Chronic Abscc\s of the Pterygomandibular Space. J. Oral Surg. 28: 424-431. I970 4. Curran, J. B.: Coronoid Surgery After Subcondylar O\teotomy: Report of Cases. J. Oral Surg. 29: 344-34X. 1971. of the Coronoid tcr the ;/ygomatlc s. Findlar. I. A.: Ankylosis Bone. Br. J. Oral Surg. 10: 30-34. 1972. 6. Guralnick. W. G.. and Kaban, L. B.: Surgical Treatment of Mandibular Hypomobility, J. Oral Surg. 34: 333-34X. 1976. 7. Khosla. V. M.: Paeudoankylosis of Mandible Produced by Temporal Muscle Fibrosis: A Report of a Case. J. Oral Surg. 2X: 521-522. 1970. Following a 8. Kwapis, B. W.. and Dyer, M. H.: Pseudoankvlosls Temporoparietal Craniotomy and Its Surgical C’orrcction. J. Oral Surg. 32: 912-914, 19??. Resultlug From a 9. Marlette, R. H.: Trismus and Pseudoankyloais Coronoid-Zygomatic-Maxillary Fusion. J. Oral Surg 21: I S6162, 1963. of the 10. Sanders. B.. Thorpe. W., and Kallal. R.: Pseudoankylosis Mandible Secondary to Transcoronal Neurosurpical Prl)cedure. J. Oral Surg. 32: 909-911. 1973. I I. Williams, A. C.. and others: Ankylosia of ths Coroncjld Proces\ to the Zygomatlc Arch and Maxilla: Report of Ca\c, J. Oral Surg. 26: 80+X06. 1968.

procedures. of the ca\c.

and the procc-

Rqv+nt rryrrc’sts to: Dr. John M. Alexander Department of Oral and Maxillofacial Box 637 Medical College of Virginia Richmond, Va. 2329X

Surgery