case 8: trismus

Question 1

Case Summary

Answer 1

C/O - 27 y/o woman suddenly unable to open normally after chewing tough meat, pain in front of right ear, 10 year history of painless click RHS TMJ.
RMH - previous knee pain diagnosed as ‘generalised hypermobility’, used to be a gymnastics.
EO - MoM tenderness, increased range of mvmnt in fingers, wrists and elbows.
IO - 23mm opening, RHS 1mm excursion, LHS 7mm excursion, normal occlusion.

Question 2

Define Trismus

Answer 2

reduced mouth opening caused by spasm of the muscles supplied by the trigeminal nerve.

(can be permanent or temporary)

Question 3

3 common causes of TMJ pain:

Answer 3

1. osteoarthritis (wear and tear as opposed to inflammation of RA)
2. internal derangement (displacement of the disc)
3. TMJ disorder with myofacial pain

Question 4

Why might the TMJ click?

Answer 4

• the fibrous disc becomes displaced in front of the condylar head on opening (opening click)
• when overcome it snaps back into place on closing (closing click)

Question 5

Why might the TMJ lock?

Answer 5

• articular disc becomes grossly displaced
• stops anterior translation of the condyle
• pt may complain of locking when half open

Question 6

How to manage TMJ issues.

Answer 6

• analgesia (paracetamol or NSAIDs)
• warm or cold compress and gentle mobilisation
• physio exercises

Question 7

Is there any significance of the joint hypermobility?

Answer 7

Possibility of Ehlers Danlos -
would make the pt more susceptible to TMJ internal derangement.