Trismus - wikipedia Trismus Trismus Classification and external resources ICD - 10 R25. 2 ICD - 9 - CM 781.0 DiseasesDB 27801 MeSH D014313 ( edit on Wikidata ) Trismus, also called lockjaw, is reduced opening of the jaws ( limited jaw range of motion ). It may be caused by spasm of the muscles of mastication or a variety of other causes. Temporary trismus occurs much more frequently than permanent trismus. It is known to interfere with eating, speaking, and maintaining proper oral hygiene. This interference, specifically with the patient 's ability to swallow properly, results in an increased risk of aspiration. In some instances, trismus presents with altered facial appearance. The condition may be distressing and painful for the patient. Examination and treatments requiring access to the oral cavity can be limited, or in some cases impossible, due to the nature of the condition itself. Contents 1 Definition 2 Differential diagnosis 2.1 Joint problems 2.1. 1 Ankylosis 2.1. 2 Arthritis synovitis 2.1. 3 Meniscus pathology 2.2 Extra-articular causes 2.2. 1 Infection 2.2. 2 Dental treatment 2.2. 3 Trauma 2.2. 4 TMJ disorders 2.2. 5 Tumors and oral care 2.2. 6 Drug therapy 2.2. 7 Radiotherapy and chemotherapy 2.2. 8 Congenital and developmental causes 2.2. 9 Miscellaneous disorders 2.3 Common causes 2.4 Other causes 3 Diagnostic approach 4 Treatment 5 History 6 References Definition Trismus is defined as painful restriction in opening the mouth due to a muscle spasm, however it can also refer to limited mouth opening of any cause. Another definition of trismus is simply a limitation of movement. Historically and commonly, the term lock jaw was sometimes used as a synonym for both trismus and tetanus. Normal mouth - opening ranges from 35 to 45 mm. Males usually have slightly greater mouth opening than females. ( 40 -- 60 mm, average of 35 mm ). The normal lateral movement is 8 - 12 mm, and normal protrusive movement is approximately 10 mm. Some have distinguished mild trismus as 20 -- 30 mm interincisal opening, moderate as 10 -- 20 mm and severe as less than 10 mm. Trismus is derived from the Greek word trigmos / trismos meaning `` a scream ; a grinding, rasping or gnashing ''. Differential diagnosis Traditionally causes of trismus are divided into intra-articular ( factors within the temporomandibular joint ( TMJ ) ) and extra-articular ( factors outside the joint, see table ). Commonly listed causes of trismus Intra-articular : Internal derangement of TMJ / meniscus displacement. Fractured mandibular condyle or intracapsular fracture. TMJ dislocation. Traumatic synovitis. Septic arthritis. Osteoarthritis. Inflammatory arthritis ( e.g. rheumatoid or psoriatic ). Ankylosis. Osteophyte formation. Extra-articular : Trauma not involving the mandibular condyle ( e.g. a fracture of another part of the mandible, fractures of the middle third of the facial skeleton, fractures of the zygoma or zygomatic arch ). Post surgical edema, e.g. removal of impacted lower wisdom teeth, or other dentoalveolar surgery. Recent prolonged dental treatment ( e.g. root canal therapy ). Following administration of inferior alveolar nerve block with local anesthetic ( medial pterygoid ). Hematoma of medial pterygoid. Acute infections of the oral tissues, especially involving the buccal space or muscles of mastication. Odontogenic infection. Peritonsillar abscess. Acute parotitis, e.g. mumps. Pericoronitis. Submasseteric abscess. Tetanus. Tetany. Local malignancy. Myofascial pain / temporomandibular joint dysfunction. Radiation fibrosis. Fibrosis from burns. Submucous fibrosis. Systemic sclerosis. Myositis ossificans. Coronoid hyperplasia. Malignant hyperpyrexia. Epidermolysis bullosa. Drug associated dyskinesia. Psychotic disturbances, hysteria. Joint problems Ankylosis True bony ankylosis : can result from trauma to chin, infections and from prolonged immobilization following condylar fracture Treatment -- several surgical procedures are used to treat bony ankylosis, e.g. : Gap arthroplasty using interpositional materials between the cut segments. Fibrous ankylosis : usually results due to trauma and infection Treatment -- trismus appliances in conjunction with physical therapy. Arthritis synovitis Meniscus pathology Extra-articular causes Infection Odontogenic - Pulpal Periodontal Pericoronal Non-odontogenic - Peritonsillar abscess Tetanus Meningitis Brain abscess Parotid abscess The hallmark of a masticatory space infection is trismus or infection in anterior compartment of lateral pharyngeal space results in trismus. If these infections are unchecked, can spread to various facial spaces of the head and neck and lead to serious complications such as cervical cellulitis or mediastinitis. Treatment : Elimination of etiologic agent along with antibiotic coverage Trismus or lock jaw due to masseter muscle spasm, can be a primary presenting symptom in tetanus, Caused by clostridium tetani, where tetanospasmin ( toxin ) is responsible for muscle spasms. Prevention : primary immunization ( DPT ) Dental treatment Dental trismus is characterized by a difficulty in opening the jaw. It is a temporary condition with a duration usually not longer than two weeks. Dental trismus results from some sort of insult to the muscles of mastication, such as opening the jaw for a period of time or having a needle pass through a muscle. Typical dental anesthesia to the lower jaw often involves the needle passing into or through a muscle. In these cases it is usually the medial pterygoid or the buccinator muscles. Oral surgery procedures, as in the extraction of lower molar teeth, may cause trismus as a result either of inflammation to the muscles of mastication or direct trauma to the TMJ. Barbing of needles at the time of injection followed by tissue damage on withdrawal of the barbed needle causes post-injection persistent paresthesia, trismus and paresis. Treatment : in acute phase : Heat therapy Analgesics A soft diet Muscle relaxants ( if necessary ) Note : When acute phase is over the patient should be advised to initiate physiotherapy for opening and closing mouth. Trauma Fractures, particularly those of the mandible and fractures of zygomatic arch and zygomatic arch complex, accidental incorporation of foreign bodies due to external traumatic injury. Treatment : fracture reduction, removal of foreign bodies with antibiotic coverage TMJ disorders Extra-capsular disorders -- Myofascial Pain Dysfunction Syndrome Intra-capsular problems -- Disc displacement, arthritis, fibrosis, etc. Acute closed locked conditions -- displaced meniscus Tumors and oral care Rarely, trismus is a symptom of nasopharyngeal or infratemporal tumors / fibrosis of temporalis tendon, when patient has limited mouth opening, always premalignant conditions like oral submucous fibrosis ( OSMF ) should also be considered in differential diagnosis. Drug therapy Succinyl choline, phenothiazines and tricyclic antidepressants causes trismus as a secondary effect. Trismus can be seen as an extra-pyramidal side - effect of metoclopromide, phenothiazines and other medications. Radiotherapy and chemotherapy Complications of radiotherapy : Osteoradionecrosis may result in pain, trismus, suppuration and occasionally a foul smelling wound. When muscles of mastication are within the field of radiation, it leads to fibrosis and result in decreased mouth opening. Complications of Chemotherapy : Oral mucosal cells have high growth rate and are susceptible to the toxic effects of chemotherapy, which lead to stomatitis. Congenital and developmental causes Hypertrophy of coronoid process causes interference of coronoid against the anteromedial margin of the zygomatic arch. Treatment : Coronoidectomy Trismus - pseudo-camtodactyly syndrome is a rare combination of hand, foot and mouth abnormalities and trismus. Miscellaneous disorders Hysteric patients : Through the mechanisms of conversion, the emotional conflict are converted into a physical symptom. E.g. : trismus Scleroderma : A condition marked by edema and induration of the skin involving facial region can cause trismus Common causes Lock - jaw caused due to muscle rigidity. Pericoronitis ( inflammation of soft tissue around impacted third molar ) is the most common cause of trismus. Inflammation of muscles of mastication. It is a frequent sequel to surgical removal of mandibular third molars ( lower wisdom teeth ). The condition is usually resolved on its own in 10 -- 14 days, during which time eating and oral hygiene are compromised. The application of heat ( e.g. heat bag extraorally, and warm salt water intraorally ) may help, reducing the severity and duration of the condition. Peritonsillar abscess, a complication of tonsillitis which usually presents with sore throat, dysphagia, fever, and change in voice. Temporomandibular joint dysfunction ( TMD ). Trismus is often mistaken as a common temporary side effect of many stimulants of the sympathetic nervous system. Users of amphetamines as well as many other pharmacological agents commonly report bruxism as a side - effect ; however, it is sometimes mis - referred to as trismus. Users ' jaws do not lock, but rather the muscles become tight and the jaw clenched. It is still perfectly possible to open the mouth. Submucous fibrosis. Fracture of the zygomatic arch. Other causes Acute osteomyelitis Ankylosis of the TMJ ( fibrous or bony ) Condylar fracture or other trauma. Gaucher disease which is caused by deficiency of the enzyme glucocerebrosidase. Giant cell arteritis Sympathomimetic drugs, such as amphetamine, methamphetamine, MDA, MDMA, MDEA, methylphenidate, ethylphenidate, and related substances. Infection Local anesthesia ( dental injections into the infratemporal fossa ) Needle prick to the medial pterygoid muscle Oral submucous fibrosis. Radiation therapy to the head and neck. Tetanus, also called lockjaw for this reason Malignant hyperthermia Malaria severa Secondary to neuroleptic drug use Malignant otitis externa Mumps Peritonsillar abscess Retropharyngeal or parapharyngeal abscess Seizure Stroke Diagnostic approach X-ray / CT scan taken from the TMJ to see if there is any damage to the TMJ and surrounding structures. Treatment Treatment requires treating the underlying condition with dental treatments, physical therapy, and passive range of motion devices. Additionally, control of symptoms with pain medications ( NSAIDs ), muscle relaxants, and warm compresses may be used. Splints have been used. History Historically, the term trismus was used to describe the early effects of tetany, also called `` lock jaw ''. References ^ Jump up to : Odell, edited by Edward W. ( 2010 ). Clinical problem solving in dentistry ( 3rd ed. ). Edinburgh : Churchill Livingstone. pp. 37 -- 41. ISBN 9780443067846. CS1 maint : Extra text : authors list ( link ) ^ Jump up to : Soames, J.V. ; Southam, J.C. ( 1998 ). Oral pathology ( 3rd ed. ). Oxford : Oxford University Press. p. 330. ISBN 019262895X. Jump up ^ `` trismus ''. Miller - Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health ( Seventh ed. ). 2003. ^ Jump up to : Newlands, edited by Cyrus Kerawala, Carrie ( 2010 ). Oral and maxillofacial surgery. Oxford : Oxford University Press. ISBN 9780199204830. CS1 maint : Extra text : authors list ( link ) ^ Jump up to : Scully, Crispian ( 2008 ). Oral and maxillofacial medicine : the basis of diagnosis and treatment ( 2nd ed. ). Edinburgh : Churchill Livingstone. pp. 101, 353. ISBN 9780443068188. Jump up ^ Hupp JR, Ellis E, Tucker MR ( 2008 ). Contemporary oral and maxillofacial surgery ( 5th ed. ). St. Louis, Mo. : Mosby Elsevier. ISBN 9780323049030. Jump up ^ `` Etymology of Trismus on Online Etymology Dictionary ''. Douglas Harper. Retrieved 10 February 2013. ^ Jump up to : Kalantzis, Crispian Scully, Athanasios ( 2005 ). Oxford handbook of dental patient care ( 2nd ed. ). New York : Oxford University Press. ISBN 9780198566236. ^ Jump up to : Chris. `` Dr ''. Locked Jaw ( Lockjaw and Slack Jaw ) Meaning and Causes. Healthhype.com. Retrieved 13 September 2012. Jump up ^ Shulman DH, Shipman B, Willis FB ( 2008 ). `` Treating trismus with dynamic splinting : A cohort, case series ''. Adv Ther. 25 ( 1 ) : 9 -- 16. doi : 10.1007 / s12325 - 008 - 0007 - 0. PMID 18227979. Oral and maxillofacial pathology ( K00 -- K06, K11 -- K14, 520 -- 525, 527 -- 529 ) Lips Cheilitis Actinic Angular Plasma cell Cleft lip Congenital lip pit Eclabium Herpes labialis Macrocheilia Microcheilia Nasolabial cyst Sun poisoning Trumpeter 's wart Tongue Ankyloglossia Black hairy tongue Caviar tongue Crenated tongue Cunnilingus tongue Fissured tongue Foliate papillitis Glossitis Geographic tongue Median rhomboid glossitis Transient lingual papillitis Glossoptosis Hypoglossia Lingual thyroid Macroglossia Microglossia Rhabdomyoma Palate Bednar 's aphthae Cleft palate High - arched palate Palatal cysts of the newborn Inflammatory papillary hyperplasia Stomatitis nicotina Torus palatinus Oral mucosa -- Lining of mouth Amalgam tattoo Angina bullosa haemorrhagica Behçet 's disease Bohn 's nodules Burning mouth syndrome Candidiasis Condyloma acuminatum Darier 's disease Epulis fissuratum Erythema multiforme Erythroplakia Fibroma Giant - cell Focal epithelial hyperplasia Fordyce spots Hairy leukoplakia Hand, foot and mouth disease Hereditary benign intraepithelial dyskeratosis Herpangina Herpes zoster Intraoral dental sinus Leukoedema Leukoplakia Lichen planus Linea alba Lupus erythematosus Melanocytic nevus Melanocytic oral lesion Molluscum contagiosum Morsicatio buccarum Oral cancer Benign : Squamous cell papilloma Keratoacanthoma Malignant : Adenosquamous carcinoma Basaloid squamous carcinoma Mucosal melanoma Spindle cell carcinoma Squamous cell carcinoma Verrucous carcinoma Oral florid papillomatosis Oral melanosis Smoker 's melanosis Pemphigoid Benign mucous membrane Pemphigus Plasmoacanthoma Stomatitis Aphthous Denture - related Herpetic Smokeless tobacco keratosis Submucous fibrosis Ulceration Riga -- Fede disease Verruca vulgaris Verruciform xanthoma White sponge nevus Teeth ( pulp, dentin, enamel ) Amelogenesis imperfecta Ankylosis Anodontia Caries Early childhood caries Concrescence Failure of eruption of teeth Dens evaginatus Talon cusp Dentin dysplasia Dentin hypersensitivity Dentinogenesis imperfecta Dilaceration Discoloration Ectopic enamel Enamel hypocalcification Enamel hypoplasia Turner 's hypoplasia Enamel pearl Fluorosis Fusion Gemination Hyperdontia Hypodontia Maxillary lateral incisor agenesis Impaction Wisdom tooth impaction Macrodontia Meth mouth Microdontia Odontogenic tumors Keratocystic odontogenic tumour Odontoma Dens in dente Open contact Premature eruption Neonatal teeth Pulp calcification Pulp stone Pulp canal obliteration Pulp necrosis Pulp polyp Pulpitis Regional odontodysplasia Resorption Shovel - shaped incisors Supernumerary root Taurodontism Trauma Avulsion Cracked tooth syndrome Vertical root fracture Occlusal Tooth loss Edentulism Tooth wear Abrasion Abfraction Acid erosion Attrition Periodontium ( gingiva, periodontal ligament, cementum, alveolus ) -- Gums and tooth - supporting structures Cementicle Cementoblastoma Gigantiform Cementoma Eruption cyst Epulis Pyogenic granuloma Congenital epulis Gingival enlargement Gingival cyst of the adult Gingival cyst of the newborn Gingivitis Desquamative Granulomatous Plasma cell Hereditary gingival fibromatosis Hypercementosis Hypocementosis Linear gingival erythema Necrotizing periodontal diseases Acute necrotizing ulcerative gingivitis Pericoronitis Peri-implantitis Periodontal abscess Periodontal trauma Periodontitis Aggressive As a manifestation of systemic disease Chronic Perio - endo lesion Teething Periapical, mandibular and maxillary hard tissues -- Bones of jaws Agnathia Alveolar osteitis Buccal exostosis Cherubism Idiopathic osteosclerosis Mandibular fracture Microgenia Micrognathia Intraosseous cysts Odontogenic : periapical Dentigerous Buccal bifurcation Lateral periodontal Globulomaxillary Calcifying odontogenic Glandular odontogenic Non-odontogenic : Nasopalatine duct Median mandibular Median palatal Traumatic bone Osteoma Osteomyelitis Osteonecrosis Bisphosphonate - associated Neuralgia - inducing cavitational osteonecrosis Osteoradionecrosis Osteoporotic bone marrow defect Paget 's disease of bone Periapical abscess Phoenix abscess Periapical periodontitis Stafne defect Torus mandibularis Temporomandibular joints, muscles of mastication and malocclusions -- Jaw joints, chewing muscles and bite abnormalities Bruxism Condylar resorption Mandibular dislocation Malocclusion Crossbite Open bite Overbite Overeruption Overjet Prognathia Retrognathia Scissor bite Maxillary hypoplasia Temporomandibular joint dysfunction Salivary glands Benign lymphoepithelial lesion Ectopic salivary gland tissue Frey 's syndrome HIV salivary gland disease Necrotizing sialometaplasia Mucocele Ranula Pneumoparotitis Salivary duct stricture Salivary gland aplasia Salivary gland atresia Salivary gland diverticulum Salivary gland fistula Salivary gland hyperplasia Salivary gland hypoplasia Salivary gland neoplasms Benign : Basal cell adenoma Canalicular adenoma Ductal papilloma Monomorphic adenoma Myoepithelioma Oncocytoma Papillary cystadenoma lymphomatosum Pleomorphic adenoma Sebaceous adenoma Malignant : Acinic cell carcinoma Adenocarcinoma Adenoid cystic carcinoma Carcinoma ex pleomorphic adenoma Lymphoma Mucoepidermoid carcinoma Sclerosing polycystic adenosis Sialadenitis Parotitis Chronic sclerosing sialadenitis Sialectasis Sialocele Sialodochitis Sialosis Sialolithiasis Sjögren 's syndrome Orofacial soft tissues -- Soft tissues around the mouth Actinomycosis Angioedema Basal cell carcinoma Cutaneous sinus of dental origin Cystic hygroma Gnathophyma Ludwig 's angina Macrostomia Melkersson -- Rosenthal syndrome Microstomia Noma Oral Crohn 's disease Orofacial granulomatosis Perioral dermatitis Pyostomatitis vegetans Other Eagle syndrome Hemifacial hypertrophy Facial hemiatrophy Oral manifestations of systemic disease Symptoms and signs : nervous and musculoskeletal systems ( R25 -- R29, 781.0, 781.2 -- 9 ) Primarily nervous system Primarily CNS Movement disorders Dyskinesia : Athetosis Tremor Gait abnormality Scissor gait Cerebellar ataxia Festinating gait Marche a petit pas Propulsive gait Stomping gait Spastic gait Magnetic gait Lack of coordination Dyskinesia : Ataxia Cerebellar ataxia / Dysmetria Sensory ataxia Dyssynergia Dysdiadochokinesia Asterixis Other Abnormal posturing : Opisthotonus Sensory processing disorder : Hemispatial neglect Facial weakness Hyperreflexia Pronator drift Primarily PNS Gait abnormality Steppage gait Antalgic gait Primarily muscular Movement disorders Spasm Trismus Fasciculation Fibrillation Myokymia Cramp Gait abnormality Myopathic gait Trendelenburg gait Pigeon gait Other Tetany Meningism Primarily skeletal Rachitic rosary Clubbing Primarily joint Joint locking Retrieved from `` https://en.wikipedia.org/w/index.php?title=Trismus&oldid=854085159 '' Categories : Symptoms and signs : musculoskeletal system Pathology of temporomandibular joints, muscles of mastication and associated structures Hidden categories : CS1 maint : Extra text : authors list Infobox medical condition All articles with unsourced statements Articles with unsourced statements from March 2017 Talk Contents About Wikipedia Català Deutsch Ελληνικά Español Français 한국어 Ido Íslenska Italiano עברית Қазақша Polski Português Русский Svenska 7 more Edit links This page was last edited on 8 August 2018, at 21 : 29 ( UTC ). 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Question: one of the first signs of the onset of tetanus is trismus also referred to as
Answer: lockjaw