We at Sinha Dental Clinic have Outpatient Dental Treatments available as well as private wards for patients who have travelled from far as well as who have undergone extensive oral surgical procedures.
We have highly equipped dental clinic as well as a fully functional operation theatres for extensive oral surgical procedures.
What is trismus?
Trismus, also sometimes called lockjaw, is a painful condition in which the chewing muscles of the jaw become contracted and sometimes inflamed, preventing the mouth from fully opening. For most people, fully opening the mouth means opening it beyond 35 millimeters (mm) wideTrusted Source — a little greater than the width of two fingers.
When the mouth’s opening movement is restricted, a number of problems can arise. These include feeding and swallowing problems, oral hygiene issues, and even difficulty speaking. While trismus is not widespread in the population, it’s sometimes commonly seen in certain groups, particularly in those who:
have had oral surgery to remove their wisdom teeth
have had head and neck cancer in a region involving structures that influence mouth movement
have undergone surgery or radiation treatment to the head and neck
Trismus is not the same condition as tetanus, which is also sometimes called lockjaw. Tetanus is an infection caused by the bacterium Clostridium tetani. Because there’s a vaccine for preventing tetanus, it’s a rare infection in the United States. However, when tetanus does occur, one will have muscle stiffness and spasms that are painful and could occur anywhere in the body. A notable area where this occurs is in the head and neck region, where it causes trismus.
Trismus can occur when there’s damage or injury to the muscles of the jaw. This can happen due to: Trauma
Examples of this include when bones of the jaw are fractured or when they’re immobilized to let a fracture heal.
While trismus can arise after any oral surgery, it’s sometimes seen after the extraction of wisdom teeth, especially the lower wisdom teeth. (Wisdom teeth are the last molars on each side of the jaw.) Trismus can occur due to the inflammation the surgery creates or the hyperextension of the jaw during the procedure. It can also happen when a needle delivering the anesthetic inadvertently damages surrounding tissue. Learn more about recovery after wisdom tooth removal.
Temporomandibular joint disorder (TMJD)
On each side of your jaw there’s a temporomandibular joint. This joint acts as a sliding hinge, connecting your jaw to your skull and allowing you to open and shut your mouth. When there’s dysfunction in the joint, it can cause trismus and pain. Joint dysfunction can happen due to:
stress-related behaviors like the habitual clenching and grinding of teeth
According to research studies, up to 11.2 percent of people with TMJD report having difficulty opening their jaw.
Radiation for head and throat cancer
Tumors that interfere with the function of the jaw itself can lead to trismus. But it more commonly occurs due to radiation of cancer involving the jaw. This can cause damage and lead to the creation of scar tissue around the joint area.
The Oral Cancer Foundation states that 10 to 40 percent of those with head and neck cancer receiving radiation will develop trismus. Radiation that affects the temporomandibular joint, the pterygoid muscles, or masseter muscle (all of which play a major role in chewing) is most likely to cause trismus. The risk of trismus also seems to be dose related. A 2016 study noted that every 10-Gy increase in radiation (after an initial 40-Gy dose) to a pterygoid muscle ups the risk of trismus by 24 percent. Gy is a unit of measurement for radiation therapy.
What are the symptoms?
A mouth that will not fully open — causing opening difficulty — is the hallmark of trismus. Other symptoms may include:
pain in the jaw, even without movement
difficulty or discomfort performing activities that involve opening the mouth wide (things like brushing your teeth or biting into an apple)
inability to chew or swallow certain foods
cramping in the jaw
How it’s diagnosed
Your doctor will first perform a thorough medical exam, specifically looking for signs of oral cancer, bone and joint abnormalities, or any other abnormal tissue in your jaw that may lead to trismus. They’ll also:
measure how wide you can open your mouth
ask about any recent dental treatments or procedures
ask about any possible injuries to your jaw — for example, if you were hit in the jaw during a sporting or car accident
ask about any history of prior surgery or radiation therapy to your head and neck
order imaging studies such as a CT scan or an MRI scan to help determine whether your trismus is stemming from a problem with your joints or tissues
Trismus is more commonly temporary than permanent. But the earlier you start treatment, the better the chance for a greater recovery. Some treatment options include:
Use of a jaw-stretching device. These devices fit between the upper and lower jaw. A physical therapist will tell you which stretches to perform and how often. Studies indicate the devices may help increase the mouth opening by 5 to 10 mmTrusted Source.
Medication. Your doctor may recommend or prescribe a muscle relaxant, pain reliever, or anti-inflammatory medication. In one study, those who had the anti-inflammatories prednisolone (glucocorticosteroid) and diclofenac (nonsteroidal anti-inflammatory drug)Trusted Source injected intramuscularly after wisdom teeth extraction had less trismus than those given prednisolone alone.
Physical therapy that involves massaging and jaw stretching.
A change to a predominately soft-food diet until symptoms improve.
Managing trismus at home
Together with medical intervention, there are things you can do at home to help relieve trismus and prevent it from worsening. You can try these two or three times during the day.
Massage. Find the areas of your jaw that are painful and, moving your fingers in a circular motion, massage the area for about 30 seconds.
Move your jaw left to right, hold for a few seconds, and then move it right to left.
Move your jaw in a circular motion. Make 5 circles to the left, and 5 to the right.
Open your mouth as wide as you comfortably can, holding this position to stretch it for a few seconds.
Stretch your neck. Tuck your chin into your chest and hold for 30 seconds, then bring your head back and hold for another 30 seconds. Similarly, move your head to the left and then the right. Finally, move your head in a circular motion.
Avoid clenching your jaw shut or grinding your teeth together.
Tests and procedures used to diagnose salivary gland tumors include:
Physical exam. Your doctor will feel your jaw, neck and throat for lumps or swelling.
Imaging tests. Imaging tests, such as magnetic resonance imaging (MRI), computerized tomography (CT), positron emission tomography (PET), ultrasound or X-ray, may help your doctor determine the size and location of your salivary gland tumor.
Collecting of a sample of tissue for testing (biopsy). To collect a sample of tissue, your doctor may recommend a fine-needle aspiration or a core needle biopsy. During the biopsy, the doctor inserts a thin needle into the salivary gland to draw out a sample of suspicious cells. Doctors in a lab analyze the sample to determine what types of cells are involved and whether the cells are cancerous.
Determining the extent of salivary gland cancer
If you’re diagnosed with salivary gland cancer, your doctor will determine the extent (stage) of your cancer. Your cancer’s stage determines your treatment options and gives your doctor an idea of your prognosis.
Cancer stages are identified by Roman numerals, with stage I indicating a small, localized tumor and stage IV indicating an advanced cancer that has spread to the lymph nodes in the neck or to distant parts of the body.
Treatment for salivary gland tumors is usually with surgery to remove the tumor. People with salivary gland cancers may need additional treatments, such as with radiation therapy and chemotherapy.
Surgery for salivary gland tumors may include:
Removing a portion of the affected salivary gland. If your tumor is small and located in an easy-to-access spot, your surgeon may remove the tumor and a small portion of healthy tissue that surrounds it.
Removing the entire salivary gland. If you have a larger tumor, your doctor may recommend removing the entire salivary gland. If your tumor extends into nearby structures — such as the facial nerves, the ducts that connect your salivary glands, facial bones and skin — these also may be removed.
Removing lymph nodes in your neck. Your surgeon may recommend removing some lymph nodes from your neck if your salivary gland tumor is cancerous and there’s a risk that the cancer has spread to the lymph nodes. The surgeon removes the lymph nodes that are most likely to contain cancerous cells.
Reconstructive surgery. After surgery to remove the tumor, your doctor may recommend reconstructive surgery to repair the area. If bone, skin or nerves are removed during your surgery, these may need to be repaired or replaced with reconstructive surgery.
During reconstructive surgery, the surgeon works to make repairs that improve your ability to chew, swallow, speak, breathe and move your face. You may need transfers of skin, tissue, bone or nerves from other parts of your body to rebuild areas in your mouth, face, throat or jaws.
Salivary gland surgery can be difficult because several important nerves are located in and around the glands. For example, a nerve in the face that controls facial movement runs through the parotid gland.
Removing tumors that involve important nerves may require stretching or cutting the nerves. This can cause partial or complete paralysis of your face (facial droop) that can be temporary or, in some situations, permanent. Surgeons take care to preserve these nerves whenever possible. Sometimes severed nerves can be repaired with nerves taken from other areas of your body or with processed nerve grafts from donors.
If you’re diagnosed with salivary gland cancer, your doctor may recommend radiation therapy. Radiation therapy uses high-powered energy beams, such as X-rays and protons, to kill cancer cells. During radiation therapy, you lie on a table while a machine moves around you, directing high-powered beams at specific points on your body.
A newer type of radiation therapy that uses particles called neutrons may be more effective in treating certain salivary gland cancers. More study is needed to understand the benefits and risks of this treatment. Neutron radiation therapy isn’t widely available in the United States.
Radiation therapy can be used after surgery to kill any cancer cells that might remain. If surgery isn’t possible because a tumor is very large or is located in a place that makes removal too risky, your doctor may recommend radiation alone or in combination with chemotherapy.
Chemotherapy is a drug treatment that uses medications to kill cancer cells. Chemotherapy isn’t currently used as a standard treatment for salivary gland cancer, but researchers are studying its use.
Chemotherapy may be an option for people with advanced salivary gland cancer. It’s sometimes used in combination with radiation therapy.
Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.
When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.
Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving
Oral and Maxillofacial Surgeons are able to provide their patients with a wide range of facial cosmetic services to meet their evolving needs. Facial cosmetic surgery services can address physical imperfections resulting from birth defects, facial trauma, disease, and aging. Oral and Maxillofacial Surgeons have been leaders in the facial reconstruction of the soft tissue (skin, muscles, and cartilage), and osseous (bone) structures of the face. With the unique education of dentistry and medicine and with a specific focus on facial cosmetics, this extensive knowledge enables them to incorporate a patient’s desired result with the necessary balance of creating harmony between facial aesthetics and facial function.
In recent years, there has been an increased emphasis with a multitude of advances in cosmetic procedures to restore a patient’s youthful appearance. Oral and Maxillofacial Surgeons have the ability to carry out the entire spectrum of facial cosmetic surgery, from skin care and non-surgical enhancements to minimally invasive, as well as full surgical, rejuvenation of the face and associated structures to restore each patient’s youthful appearance and minimize the progression of the aging process. Today, people have busy and active lifestyles and they have the desire to stay looking young with minimal down time and low risk. Your Oral and Maxillofacial Surgeon is able to offer local and/or intravenous anaesthesia services to allow many facial cosmetic procedures to be performed in an office setting with same-day surgery.
Cosmetic surgical procedures available by Oral and Maxillofacial Surgeons may include:
Botox, Dermal fillers, Fat transfer
Genioplasty (chin surgery)
Facial Implants (including chin implants and cheekbone implants)
Liposuction (of the face and neck)
Blepharoplasty (eyelid surgery/orbital surgery)
Brow lift, Mid-cheek, and Mid-face lifts
Skin Care and Skin Resurfacing (i.e. skin products, chemical peels, dermabrasion, non-ablative, and ablative laser treatments)
Rhinoplasty (nasal reconstruction)
Otoplasty (cosmetic ear surgery)
Eyelash Growth Enhancement (treatment of hypotrichosis)