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{{CMG}}
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{{CMG}} {{AE}} {{CZ}} {{LRO}}


==Overview==
==Overview==
{{SI}}
'''Trismus''' (also known as lock jaw) is the inability to normally open the mouth due to one of many causes.
'''Trismus''' (also known as lock jaw) is the inability to normally open the mouth due to one of many causes.


==Common Causes==
==Causes==
*Pericoronitis (inflammation of soft tissue around impacted third molar) is the most common cause of trismus.
<div style="-webkit-user-select: none;">
*Inflammation of [[Mastication#Muscles_of_mastication|muscles of mastication]]. It is a frequent sequel to surgical removal of mandibular third molars (lower [[wisdom teeth]]). The condition usually resolves on its own in 10-14 days, during which time eating and [[oral hygiene]] is 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.
===Life Threatening Causes===
*[[Peritonsillar abscess]], a complication of [[tonsillitis]] which usually presents with sore throat, [[dysphagia]], [[fever]], and change in voice.
*[[Acute osteomyelitis]]
*[[Temporomandibular joint disorder]] (TMJ)
*[[Coral snake poisoning ]]
*[[Dental tissue neoplasm ]]
*[[Fibrosis ]]
*[[Funnel web spider poisoning ]]
*[[Horseshoe crab poisoning]]
===Common Causes===
*Acute [[osteomyelitis]]
*[[Ankylosis]]
*[[Condyloid process|Condylar]] fracture
*[[Gaucher disease]]
*[[Local anesthesia]]
*[[Pericoronitis]]
*Inflammation of [[mastication]] [[muscles]]
*[[Peritonsillar abscess]]
*[[Radiation therapy]]
*[[Temporomandibular joint disorder]]
*[[Tetanus]]


==Other Causes==
===Causes by Organ System===
*Acute [[osteomyelitis]]
{|style="width:80%; height:100px" border="1"
*[[Ankylosis]] of the TMJ (fibrous or bony)
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
*[[Condyloid process|Condylar]] fracture or other trauma.
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Ludwig angina]],  [[Stroke]]
*[[Gaucher disease]] which is caused by deficiency of the enzyme [[glucocerebrosidase]].
|-
*Infection
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| [[Coral snake poisoning ]],  [[Funnel web spider poisoning ]],  [[Horseshoe crab poisoning]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| [[Broken jaw]],  [[Coronoid hyperplasia]],  [[Damage to the trigeminal nerve]],  [[Dental caries ]],  [[Dental tissue neoplasm ]],  [[Drug associated dyskinesia]],  [[Fractured mandibular condyle ]],  [[Idiopathic orofacial dystonia]],  [[Impacted wisdom tooth]],  [[Jaw ankylosis]],  [[Jaw pain]],  [[Odontogenic infection]],  [[Pericoronitis ]],  [[Peritonsillar abscess]],  [[Post surgical edema]],  [[Prolonged dental treatment ]],  [[Quinsy]],  [[Submasseteric abscess]],  [[Submucous fibrosis]],  [[Supraglottic laryngeal cancer ]],  [[Temporomandibular joint disorder ]],  [[Tm joint disorder]],  [[Tonsillitis]],  [[Trismus pseudocamptodactyly syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Epidermolysis bullosa]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Acetaminophen]],  [[Amphetamine]],  [[Drug associated dyskinesia]],  [[Local anesthesia]],  [[Mdma]],  [[Perphenazine]],  [[Strychnine ]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Oral submucous fibrosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Crisponi syndrome]],  [[Gaucher disease ]],  [[Iida-kannari syndrome ]],  [[Trismus pseudocamptodactyly syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Hematoma of medial pterygoid]],  [[Hypocalcemia]],  [[Stroke]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Local anesthesia]],  [[Malignant hyperpyrexia]],  [[Post surgical edema]],  [[Prolonged dental treatment ]],  [[Radiation fibrosis]],  [[Radiation therapy ]],  [[Surgery]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Acute parotitis]],  [[Clostridium tetani]],  [[Infection]],  [[Ludwig angina]],  [[Mumps]],  [[Myositis]],  [[Odontogenic infection]],  [[Pericoronitis ]],  [[Peritonsillar abscess]],  [[Quinsy]],  [[Rabies]],  [[Submasseteric abscess]],  [[Tetanus]],  [[Tonsillitis]],  [[Trichinella spiralis]],  [[Trichiniasis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| [[Acute osteomyelitis]],  [[Ankylosis ]],  [[Arthrogryposis ]],  [[Fibrosis ]],  [[Iida-kannari syndrome ]],  [[Inflammation of the muscles of mastication]],  [[Mastication muscle inflammation]],  [[Medial pterygoid]],  [[Myofascial pain]],  [[Myositis]],  [[Osteoarthritis]],  [[Osteophyte formation]],  [[Tetanus]],  [[Tm joint disorder]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Acute osteomyelitis]],  [[Facial neuralgia]],  [[Facial pain]],  [[Facial trauma]],  [[Neuroleptics]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Coronoid hyperplasia]],  [[Dental tissue neoplasm ]],  [[Local malignancy]],  [[Mucoepidermoid carcinoma ]],  [[Supraglottic laryngeal cancer ]],  [[Tumors]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Hysteria]],  [[Malingering]],  [[Seizure disorder]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Arthritis]],  [[Fibrosis ]],  [[Hypocalcemia]],  [[Jaw ankylosis]],  [[Osteoarthritis]],  [[Osteophyte formation]],  [[Psoriatic arthritis]],  [[Radiation fibrosis]],  [[Rheumatoid arthritis]],  [[Scleroderma]],  [[Septic arthritis]],  [[Submucous fibrosis]],  [[Systemic lupus erythematosus]],  [[Systemic sclerosis]],  [[Traumatic synovitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Broken jaw]],  [[Burns]],  [[Condylar fracture ]],  [[Damage to the trigeminal nerve]],  [[Dental caries ]],  [[Facial trauma]],  [[Jaw pain]],  [[Needle prick]],  [[Trauma ]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}
===Causes in Alphabetical Order===
{{columns-list|
*[[Acetaminophen]]
*[[Acute parotitis]]
*[[Acute osteomyelitis]]
*[[Amphetamine]]
*[[Ankylosis ]]
*[[Arthritis]]
*[[Arthrogryposis ]]
*[[Broken jaw]]
*[[Burns]]
*[[Clostridium tetani]]
*[[Condylar fracture ]]
*[[Coral snake poisoning ]]
*[[Coronoid hyperplasia]]
*[[Crisponi syndrome]]
*[[Damage to the trigeminal nerve]]
*[[Dental caries ]]
*[[Dental tissue neoplasm ]]
*[[Drug associated dyskinesia]]
*[[Epidermolysis bullosa]]
*[[Facial neuralgia]]
*[[Facial pain]]
*[[Facial trauma]]
*[[Fibrosis ]]
*[[Fractured mandibular condyle ]]
*[[Funnel web spider poisoning ]]
*[[Gaucher disease ]]
*[[Hematoma of medial pterygoid]]
*[[Horseshoe crab poisoning]]
*[[Hypocalcemia]]
*[[Hysteria]]
*[[Idiopathic orofacial dystonia]]
*[[Iida-kannari syndrome ]]
*[[Impacted wisdom tooth]]
*[[Infection]]
*[[Jaw ankylosis]]
*[[Jaw pain]]
*[[Local anesthesia]]
*[[Local anesthesia]]
*Needle prick to the [[medial pterygoid muscle]]
*[[Local malignancy]]
*Oral submucous fibrosis.
*[[Ludwig angina]]
*[[Radiation therapy]] to the head and neck.
*[[Malignant hyperpyrexia]]
*[[Malingering]]
*[[Mastication muscle inflammation]]
*[[Mdma]]
*[[Medial pterygoid]]
*[[Mucoepidermoid carcinoma ]]
*[[Mumps]]
*[[Myofascial pain]]
*[[Myositis]]
*[[Neuroleptics]]
*[[Odontogenic infection]]
*[[Oral submucous fibrosis]]
*[[Osteoarthritis]]
*[[Osteophyte formation]]
*[[Pericoronitis ]]
*[[Peritonsillar abscess]]
*[[Perphenazine]]
*[[Post surgical edema]]
*[[Prolonged dental treatment ]]
*[[Psoriatic arthritis]]
*[[Quinsy]]
*[[Rabies]]
*[[Radiation fibrosis]]
*[[Radiation therapy ]]
*[[Rheumatoid arthritis]]
*[[Scleroderma]]
*[[Seizure disorder]]
*[[Septic arthritis]]
*[[Stroke]]
*[[Strychnine ]]
*[[Submasseteric abscess]]
*[[Submucous fibrosis]]
*[[Supraglottic laryngeal cancer ]]
*[[Surgery]]
*[[Systemic lupus erythematosus]]
*[[Systemic sclerosis]]
*[[Temporomandibular joint disorder ]]
*[[Tetanus]]
*[[Tetanus]]
* Drugs Side Effects: [[Acetaminophen]],
*[[Tonsillitis]]
*[[Trauma ]]
*[[Traumatic synovitis]]
*[[Trichinella spiralis]]
*[[Trichiniasis]]
*[[Trismus pseudocamptodactyly syndrome]]
*[[Tumors]]
}}
</div>


==Treatment==
==Treatment==
Treatment requires treating the underlying condition.  Additionally, control of symptoms with pain medications ([[NSAID]]s), [[muscle relaxants]], and warm compresses may be used.
Treatment requires treating the underlying condition.  Additionally, control of symptoms with pain medications ([[NSAID]]s), [[muscle relaxants]], and warm compresses may be used.
 
In the management of trismus, therapeutic approaches are tailored to address the underlying cause. The primary treatment strategy involves symptomatic relief. Common interventions during the acute phase include the application of **heat therapy**, the use of [[analgesics]] such as nonsteroidal anti-inflammatory drugs (NSAIDs), and [[muscle relaxants]]. Heat therapy typically involves the placement of moist, heated towels on the affected area for 15 to 20 minutes each hour. For pain relief, [[aspirin]] is often deemed adequate. In cases where muscle relaxation is necessary, a [[benzodiazepine]] like [[diazepam]] may be prescribed, with dosages ranging from 2.5 to 5 milligrams taken thrice daily. Additionally, healthcare providers may recommend a [[soft diet]] to patients for the duration of the condition. <ref> Santiago-Rosado LM, Lewison CS. Trismus. [Updated 2022 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493203/
</ref>


==References==
==References==

Latest revision as of 15:06, 16 April 2024

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Luke Rusowicz-Orazem, B.S.

Overview

Trismus (also known as lock jaw) is the inability to normally open the mouth due to one of many causes.

Causes

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular Ludwig angina, Stroke
Chemical/Poisoning Coral snake poisoning , Funnel web spider poisoning , Horseshoe crab poisoning
Dental Broken jaw, Coronoid hyperplasia, Damage to the trigeminal nerve, Dental caries , Dental tissue neoplasm , Drug associated dyskinesia, Fractured mandibular condyle , Idiopathic orofacial dystonia, Impacted wisdom tooth, Jaw ankylosis, Jaw pain, Odontogenic infection, Pericoronitis , Peritonsillar abscess, Post surgical edema, Prolonged dental treatment , Quinsy, Submasseteric abscess, Submucous fibrosis, Supraglottic laryngeal cancer , Temporomandibular joint disorder , Tm joint disorder, Tonsillitis, Trismus pseudocamptodactyly syndrome
Dermatologic Epidermolysis bullosa
Drug Side Effect Acetaminophen, Amphetamine, Drug associated dyskinesia, Local anesthesia, Mdma, Perphenazine, Strychnine 
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Oral submucous fibrosis
Genetic Crisponi syndrome, Gaucher disease , Iida-kannari syndrome , Trismus pseudocamptodactyly syndrome
Hematologic Hematoma of medial pterygoid, Hypocalcemia, Stroke
Iatrogenic Local anesthesia, Malignant hyperpyrexia, Post surgical edema, Prolonged dental treatment , Radiation fibrosis, Radiation therapy , Surgery
Infectious Disease Acute parotitis, Clostridium tetani, Infection, Ludwig angina, Mumps, Myositis, Odontogenic infection, Pericoronitis , Peritonsillar abscess, Quinsy, Rabies, Submasseteric abscess, Tetanus, Tonsillitis, Trichinella spiralis, Trichiniasis
Musculoskeletal/Orthopedic Acute osteomyelitis, Ankylosis , Arthrogryposis , Fibrosis , Iida-kannari syndrome , Inflammation of the muscles of mastication, Mastication muscle inflammation, Medial pterygoid, Myofascial pain, Myositis, Osteoarthritis, Osteophyte formation, Tetanus, Tm joint disorder
Neurologic Acute osteomyelitis, Facial neuralgia, Facial pain, Facial trauma, Neuroleptics
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Coronoid hyperplasia, Dental tissue neoplasm , Local malignancy, Mucoepidermoid carcinoma , Supraglottic laryngeal cancer , Tumors
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Hysteria, Malingering, Seizure disorder
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Arthritis, Fibrosis , Hypocalcemia, Jaw ankylosis, Osteoarthritis, Osteophyte formation, Psoriatic arthritis, Radiation fibrosis, Rheumatoid arthritis, Scleroderma, Septic arthritis, Submucous fibrosis, Systemic lupus erythematosus, Systemic sclerosis, Traumatic synovitis
Sexual No underlying causes
Trauma Broken jaw, Burns, Condylar fracture , Damage to the trigeminal nerve, Dental caries , Facial trauma, Jaw pain, Needle prick, Trauma
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

Treatment

Treatment requires treating the underlying condition. Additionally, control of symptoms with pain medications (NSAIDs), muscle relaxants, and warm compresses may be used. In the management of trismus, therapeutic approaches are tailored to address the underlying cause. The primary treatment strategy involves symptomatic relief. Common interventions during the acute phase include the application of **heat therapy**, the use of analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants. Heat therapy typically involves the placement of moist, heated towels on the affected area for 15 to 20 minutes each hour. For pain relief, aspirin is often deemed adequate. In cases where muscle relaxation is necessary, a benzodiazepine like diazepam may be prescribed, with dosages ranging from 2.5 to 5 milligrams taken thrice daily. Additionally, healthcare providers may recommend a soft diet to patients for the duration of the condition. [1]

References

  1. ↑ Santiago-Rosado LM, Lewison CS. Trismus. [Updated 2022 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493203/

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