I. Definition of trismus: Symptoms and Norms a. Dorland’s ...

Trismus:Diagnosis and Management Considerations for the Speech PathologistMelissa Walker, M.S. CCC-SLPKatie Burns, M.S. CCC-SLPASHANovember 16, 2006DefinitionFrom the Greek trismos; grating, grindingTraditional Definition– “Tonic contraction of the muscles of mastication” – Taber’s Cyclopedic Medical DictionaryCurrent Definition– Any restriction in mouth opening, including restriction caused by infection, trauma, surgery, or radiationCongenital or acquiredDefinitionUniform criteria is lacking!Various criteria for presence of trismus…– Mouth opening <20mm (Jen et. al., 2002)– Mouth opening <40mm (Nguyen et. al., 1988)– Severity ScalesMild, >30mm; Moderate, 15-30mm; Severe, <15mm (Thomas et. al., 1998)Generally, opening of <35-40mm a functional guidelineLess than 18-20mm, oral alimentation is difficultIncidenceReported incidence varies greatly, anywhere from 5% to 38% Incidence increases in irradiated patientsIncidence increases with head and neck cancer diagnosis– 36%, Nasopharyngeal tumors– 55%, Parapharyngeal tumors– Parotid glandComplications of TrismusPoor oral hygieneMalnutritionComplications of Decreased access for conditions associated medical procedures, with head and neck including intubationcancer treatmentsInability to use Reduced access for dentures or oral/ oral examination and pharyngeal dental proceduresprostheticsDysphagiaSpeech deficitsAspiration and related Airway compromisecomplicationsPainAnatomy ReviewBones: The MandibleOnly moveable bone in skullCapable of rapid movement Moves in multiple planesFunction: – Mastication– House teethhttp://zemlin.shs.uiuc.edu/Skull/defult.htm– Modify dimensions of vocal tractLigamentsLateral Ligament– Limits & guides movement– StabilizesSphenomandibular Ligament– Limits protrusive and mediotrusive movements– Limits passive jaw openingStylomandibular LigamentCourtesy N. Capra– Relaxes with jaw openingMusclesBumann & Lotzmann 2002www.nidcr.nih.govMuscle MovementElevationProtrusion– Masseter– External pterygoid– Temporalis– Internal pterygoid – Medial PterygoidRetractionDepression– Temporalis– Digastric– Mylohyoid– Mylohyoid– Geniohyoid– Geniohyoid– Anterior digastric– Lateral PterygoidLateral – External pterygoid– TemporalisDocument Outline

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