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Trismus can be a common complaint encountered in general dental practice. A 15-year-old female presented to the Emergency Department with a history of acute onset and worsening trismus, pain and extra-oral swelling following placement of a restoration in the lower right first molar tooth. An initial diagnosis of trismus associated with either muscular spasm or a haematoma following an inferior alveolar nerve (IAN) block was assumed. The patient was reviewed the following week, the trismus and swelling having increased. An urgent MRI scan showed a large heterogeneous mass in the right masticator space. A biopsy under general anaesthetic diagnosed a rhabdomyosarcoma. The patient was referred to the oncology team for chemo/radiotherapy treatment.
CPD/Clinical Relevance: Although ‘common things occur commonly’, it is important to remember that common symptoms and presentations can lead to more rare diagnoses. Prompt referral for specialist advice needs to be sought should first line management of trismus prove to be unsuccessful.
Article
Trismus is defined as the ‘prolonged tonic, spasm of the masticatory muscles that restrict normal mouth opening’.1 Degree of mouth opening varies widely between patients but between 40–60 mm is considered a normal range. Mild trismus is considered >30 mm, moderate between 15–30 mm and severe trismus <15 mm.2
There are many causes of trismus and it can be a common complication of dental treatment, such as the extraction of teeth, in particular lower third molars.3 Trismus is a known complication following the administration of an inferior alveolar nerve (IAN) block.2 This usually occurs if the needle has penetrated a vessel or the medial pterygoid muscle and can result in the formation of a small haematoma.3
Another common cause of trismus is masticatory space infection. These infections can be odontogenic or non-odontogenic in origin.4 Antibiotics are often required to be given immediately to prevent the spread of infection to neighbouring fascial spaces. This in turn can lead to serious complications, such as mediastinitis3 or airway compromise.
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