When a person is unable to open their mouth a normal amount, they are diagnosed with trismus. Although there are several potential causes of trismus, the most common cause in this practice is the result of surgery and/or radiation changes affecting the temporomandibular mandibular joint, the joint connecting the mandible (lower jaw bone) to the skull.
In this case, inflammation of the joint structures and/or radiation fibrosis can make the jaw opening very limited. There are other cases where muscle spasm may cause the joint to be very resistant to opening as well.
While trismus can be very uncomfortable for a patient, it can also result in serious function problems, depending on severity. Without the ability to open the mouth fully, patients may have a very difficult time maintaining proper oral hygiene, especially when the mouth opening is too small to fit a toothbrush.
Eating can also become difficult if the mouth opening is too small to fit a food-laden fork or spoon. Chewing can become difficult without sufficient space between the teeth. Eating whole fruits, sandwiches and the like can also be difficult when the mouth is unable to open large enough to bite into these foods.
Speech production can also be greatly impacted since the tongue has less room to move when articulating, or making different sounds. Consider trying to speak with your mouth shut. This is very typical of what a trismus patient experiences when there is minimal to no mouth opening.
In this case, inflammation of the joint structures and/or radiation fibrosis can make the jaw opening very limited. There are other cases where muscle spasm may cause the joint to be very resistant to opening as well.
While trismus can be very uncomfortable for a patient, it can also result in serious function problems, depending on severity. Without the ability to open the mouth fully, patients may have a very difficult time maintaining proper oral hygiene, especially when the mouth opening is too small to fit a toothbrush.
Eating can also become difficult if the mouth opening is too small to fit a food-laden fork or spoon. Chewing can become difficult without sufficient space between the teeth. Eating whole fruits, sandwiches and the like can also be difficult when the mouth is unable to open large enough to bite into these foods.
Speech production can also be greatly impacted since the tongue has less room to move when articulating, or making different sounds. Consider trying to speak with your mouth shut. This is very typical of what a trismus patient experiences when there is minimal to no mouth opening.
Trismus Management
Prevention
In this office, prevention of trismus is a primary focus. Certain radiation targets, such as the tongue, tonsil and oropharynx can often result in trismus. As such, identifying patients at a high risk for developing trismus allows us to prescribe an exercise regimen designed to minimize the effects of radiation to the temporomandibular joint.
By executing these exercises provided by the SLP department on a consistent and regular basis, you help to prevent some of the effects of radiation that may result in more severe trismus. Although it is often impossible to avoid developing some degree of trismus, by executing the prescribed exercises on a regular and consistent basis, you help to prevent temporomandibular joint implication as much as possible.
By executing these exercises provided by the SLP department on a consistent and regular basis, you help to prevent some of the effects of radiation that may result in more severe trismus. Although it is often impossible to avoid developing some degree of trismus, by executing the prescribed exercises on a regular and consistent basis, you help to prevent temporomandibular joint implication as much as possible.
Therapy
Despite following prescribed preventative measures, it is often impossible to avoid developing at least some degree of trismus following radiation treatment for tongue, mandible, tonsil and oropharynx cancers. If trismus is diagnosed and considered to impact your functional abilities (i.e., ability to eat, speak, etc), therapy may be indicated to improve your jaw opening as much as possible.
Passive stretching exercises are most commonly used to assist with improving mouth opening. The SLP staff will guide you through a program best designed to meet your needs, which may include the use of splinting devices, Therabite, a passive range of motion device, or the Dynasplint which incorporates counterbalance measures to assist with jaw opening. The SLP staff can discuss the available options in this regard as well as identify the best device for your individual needs.
Passive stretching exercises are most commonly used to assist with improving mouth opening. The SLP staff will guide you through a program best designed to meet your needs, which may include the use of splinting devices, Therabite, a passive range of motion device, or the Dynasplint which incorporates counterbalance measures to assist with jaw opening. The SLP staff can discuss the available options in this regard as well as identify the best device for your individual needs.
Botox
In some cases, trismus can be caused by, or made worse, by muscle spasms within the temporomandibular joint. In this case, the use of Botox may be helpful to assist with the management of your trismus.
Although Botox can be quite effective, it will not help trismus that is the result of radiation fibrosis or other causes. It is only effective in treating muscle spasms that may be interfering with mouth opening. Your doctor/SLP staff will determine if this treatment is appropriate for you.
If spasm is suspected to be interfering with mouth opening, electromyography (EMG) will first be used to assess the degree of muscle activity (spasm) within the joint to help determine if this course of treatment is appropriate for you.
It is important to understand that the effects of Botox are not permanent. Ideally, Botox should last 3-4 months although the effective time is different from patient to patient and dependent on several variables. Repeated injection can be performed as the effects of Botox begin to wear off to ensure your trismus is well managed.
Although Botox can be quite effective, it will not help trismus that is the result of radiation fibrosis or other causes. It is only effective in treating muscle spasms that may be interfering with mouth opening. Your doctor/SLP staff will determine if this treatment is appropriate for you.
If spasm is suspected to be interfering with mouth opening, electromyography (EMG) will first be used to assess the degree of muscle activity (spasm) within the joint to help determine if this course of treatment is appropriate for you.
It is important to understand that the effects of Botox are not permanent. Ideally, Botox should last 3-4 months although the effective time is different from patient to patient and dependent on several variables. Repeated injection can be performed as the effects of Botox begin to wear off to ensure your trismus is well managed.
Surgery
In some cases, surgery can be performed to assist with mouth opening, although following surgery, passive range of motion exercises are typically required to maintain the gains accomplished by the surgery. Without regular exercise of this manner, the trismus may potentially return to the same severity as was noticed pre-operatively. Your doctor and SLP will determine if surgical intervention is appropriate for you.
Therabite
In this practice, the most commonly utilized device for treating trismus is the Therabite Jaw Rehabilitation System. It is important to note that regular exercise with this system is required to achieve and maintain any gains in mouth opening.
Dynasplint
This system can be effective in improving jaw opening although is less commonly used as this device is rented and requires custom fitting by the manufacturer. Its utilization of counterbalance principles can be very effective in improving mouth opening.
