Article: Volume 46 Number 11 Page 1075 - December 2019

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  Dent Update 2019; 46: 1075-1077

Oral and Maxillofacial Surgery:  Acute Onset Trismus in a 15-Year-Old

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Abstract: 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.

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.

Author notes: Manal Mohammed, BDS(Hons), MFDS RCSEd, StR in Paediatric Dentistry, Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY (email: manal.mohammed@nhs.net), Andrea Beech, BDS(Hons), MJDF RCSEng, Consultant Oral Surgery and Jeremy Farrier, MBBCh BDS, Consultant Oral and Maxillofacial Surgery, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK.

Objective: To review the causes of trismus, including rare causes like rhabdomyosarcoma, and understand the importance of seeking specialist advice for unresolving acute onset trismus.