Trismus of masticatory muscles and its treatment

Trismus of the masticatory muscles is a severe spasmodic condition when the temporomandibular joint is immobilized, the masticatory muscles are very tense, they become stone-like, the teeth are clenched, and the patient cannot open his mouth freely. In such cases, urgent dental care is necessary, since the person can neither eat nor drink, respiratory function is impaired, and severe pain is felt. It is very important to provide emergency dental care as quickly as possible, since trismus puts a lot of stress on the nervous system, jaw, teeth and gum tissue.

The main causes of trismus

Often the causes of trismus are diseases that are localized near the jaw:

• osteomyelitis of the jaw;
• inflammatory process of masticatory muscles;
• jaw injuries;
• periostitis;
• advanced caries, extensive carious damage to teeth;
• inflammation of the gum tissue;
• acute stage of pulpitis;
• inflammation of the periosteum of the lower jaw;
• abscesses.

Compression can also occur in the background:

• neurosis;
• brain inflammation;
• cerebrospinal meningitis;
• epileptic seizures;
• paralysis;
• cerebral hemorrhages;
• rabies;
• muscle cramps;
• tetanus;
• tumor processes;
• hysteria.

Sometimes the disease can occur due to a direct blow to the jaw area, due to an unexpected dousing with cold water. Often a spasm occurs after an animal bite (one of the consequences of rabies).

Trismus symptoms

Trismus is characterized by the following symptoms:

• pain when trying to open or close your mouth;
• pain and swelling in the gums, teeth, lower jaw;
• Complete immobilization of the gums;
• elevated temperature (with the development of infection);
• voice change;
• headache;
• loss of appetite;
• weight loss.

Symptoms may vary depending on the nature of the trismus. The disease can develop due to metabolic processes in the body, a malignant tumor of the oral cavity, or many years of smoking.

Symptoms and degrees of trismus

• sharp contraction of the jaw;
• the patient cannot open his mouth;
• teeth are tightly clenched;
• severe pain when unclenching teeth;
• swelling and hardening of the muscle;
• breathing problems;
• speech problems;
• inability to eat normally;
• The lower part of the face may hurt, with severe pain spreading to the neck and back.

There are several stages of trismus:

• the first – when a person can open his mouth 30-40 mm;
• second – if a person is able to open his mouth slightly by 10-20 mm;
• the third is the most difficult, when the mouth opens less than 10 mm.

The consequences of strong clenching of the jaws can be chipping, loss of teeth, damage to enamel and dentin.

Diagnosing trismus requires a qualified approach, since the disease’s symptoms are similar to other problems. For example, with inflammatory processes (arthrosis) of the jaw joint or a fracture of the jaw. In this case, only an experienced traumatologist will help. To examine the oral cavity, the patient is given an injection of botulinum toxin, which has a relaxing effect on the chewing muscles and provides pain relief.

Is trismus dangerous?

Absolutely yes. Firstly, due to the inability to open the jaw normally, a person stops eating; over time, this leads to problems with the stomach and intestines and threatens physical exhaustion.

Difficulty breathing is also dangerous, as this can lead to oxygen starvation. If the jaws are tightly closed, damage to the tooth enamel is also possible.

Trismus caused by infectious (meningitis, tetanus, rabies), oncological (brain tumors) and cardiovascular (stroke) diseases is especially dangerous.

How to treat trismus of the masticatory muscle?

Treatment involves the following steps:

• jaw immobilization;
• elimination of the disease or condition that caused trismus;
• taking medications with a relaxing effect (neuropsychic stimulants);
• taking antibiotics;
• the patient takes sedatives;
• Physiotherapy is recommended.

If trismus is caused by an inflammatory process in the mouth, the dentist sanitizes the lesion (for example, opens an abscess), cleans the hole and, if necessary, removes the tooth along with the root.

Symptoms of paratonsillar abscess

The typical clinical manifestation of PTA is severe sore throat (usually unilateral), fever, and muffled voice. Patients may also complain of drooling and difficulty swallowing.

Trismus (spasm of the masticatory muscles), associated with irritation and reflex spasm of the internal pterygoid muscle, occurs in almost 2/3 of patients and is an important distinguishing feature of PTA in comparison with severe acute tonsillopharyngitis. Patients may also complain of neck swelling and ear pain on the affected side.

There are different types of seizures

Trismus of the masticatory muscles is of two types - unilateral and bilateral, which is also called bilateral. The name indicates spasm of the masticatory muscles on one or both sides of the facial part of the head.

Bilateral trismus is especially dangerous. It is a manifestation of some infectious and neurological diseases. In this case, the teeth and jaws are closed so tightly due to the lack of movement in the temporomandibular joint that there is absolutely no speech and the ability to naturally eat and drink.

Unilateral spasm is expressed on one side of the face. The lower jaw is pulled towards the tense muscles so that it becomes skewed, which intensifies when the mouth is opened.

Bilateral trismus is more often diagnosed; unilateral trismus occurs against the background of injuries, inflammatory and deformational diseases in the temporomandibular joint and in the presence of inflammation in the oral cavity.

Diagnostics

In the vast majority of cases, the diagnosis of PTA is made clinically, based on the results of pharyngoscopy (examination of the pharynx). It is confirmed by obtaining purulent discharge during drainage of the abscess or by instrumental studies (most often ultrasound).

Pharyngoscopy reveals a swollen and/or fluctuating tonsil with deviation of the uvula in the direction opposite to the lesion, hyperemia (redness) and swelling of the soft palate. In some cases, there is plaque or liquid discharge in the palatine tonsil. There is an increase and tenderness of the cervical and submandibular lymph nodes.

Bilateral PTA is extremely rare and its diagnosis is more difficult due to the lack of asymmetry in the pharynx, as well as the rarely present spasm of the masticatory muscles.

Laboratory tests are not required to make a diagnosis; they are additionally prescribed to determine the severity of the disease and select a treatment method.

Laboratory tests may include:

• general blood test with leukocyte formula;
• study of electrolytes (potassium, sodium, chlorine) for signs of dehydration;
• strepta test to exclude GABHS;
• culture for aerobic and anaerobic bacteria if the abscess was drained (culture is recommended only for complicated PTA, recurrent PTA, or in patients with immunodeficiency conditions).

Instrumental examination methods - ultrasound, computed tomography, lateral neck x-ray, magnetic resonance imaging or angiography - are not necessary and are performed to exclude other diseases if the diagnosis of PTA is not obvious.

Treatment of peritonsillar abscess

In case of a complicated course, children (especially young children) are indicated for hospitalization and treatment in a hospital setting.

The main treatment method for PTA is systemic antibacterial therapy. In severe cases, severe intoxication, difficulty swallowing, nausea, antibacterial therapy is prescribed parenterally (bypassing the gastrointestinal tract) with subsequent transfer to oral forms of drugs - until the completion of the 14-day course of treatment. Courses of antibiotic therapy for less than 10 days increase the likelihood of disease relapse.

After prescribing systemic antibiotic therapy, dynamic observation for 24 hours is recommended. It is acceptable in patients with suspected paratonsillitis, without obvious signs of PTA, without signs of airway obstruction, sepsis, severe spasm of the masticatory muscles, or other signs of a complicated course of the disease. And also in children under 7 years of age with small abscesses and rare episodes of acute tonsillopharyngitis in history.

Studies have shown that systemic antibiotic therapy is effective even without draining the abscess. According to available data, 50% of children responded to systemic antibiotic therapy and did not require abscess drainage or tonsillectomy.

Systemic antibacterial therapy should include antibiotics active against GABHS, Staphylococcus aureus and respiratory anaerobes. For PTA, amoxicillin-clavulanate, ampicillin-sulbactam, and clindamycin are most often prescribed. If there is no or severe response, vancomycin or linezolid is added to treatment to ensure optimal coverage of potentially resistant Gram-positive cocci.

Treatment

Treatment of trismus is directed at the underlying etiology and is usually treated symptomatically. Symptom-focused interventions, including heat therapy, analgesics such as non-steroidal anti-inflammatory drugs, and muscle relaxants, can be considered in the acute phase and have been described as the mainstay of treatment for uncomplicated transient trismus. Patients with post-traumatic and post-operative trismus, especially if it persists for more than 1 week, may also require stretching exercises. The exercises usually consist of repeated attempts to open the mouth against applied resistance, usually divided into several sessions per day. Trismus can become chronic due to fibrosis or ongoing radiation therapy; In these cases, intensive physical therapy, sometimes using commercially available jaw movement devices or microcurrent therapy, may help, especially in cases refractory to more conservative approaches. Some authors have also described treatment with xanthine derivatives such as pentoxifylline.

What is muscle spasm, its types and causes

Muscle spasms are involuntary contractions of muscle tissue. Unlike natural contractions (for example, during the digestion of food, during exercise, swallowing water), spasms occur without any external or internal cause, in the absence of a person’s desire, and unpredictably.

As a rule, muscle spasms in the head area affect the temples, forehead, and back of the head. Involuntary contractions of the masticatory muscles can occur due to the use of stimulants (caffeine, taurine, narcotics) or for internal physiological reasons. In the second case we are talking about:

• trismus - a spasm that provokes a tight clenching of the jaws;
• bruxism - involuntary muscle contractions that occur mainly during sleep, at night, and are accompanied by grinding of the upper and lower rows of teeth.

Muscle spasms in the cervical spine can be either unilateral or bilateral. They are often associated with pinched nerves or spinal pathologies (for example, a hernia).

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Types of head muscle spasms:

• episodic involuntary muscle contractions: headache, neck muscle pain lasts no more than 14 days over a period of 1 month;
• chronic spasms: 15 days a month or more.

Typically, the causes of spasms in the muscles of the head, jaws, and neck are:

• metabolic disease;
• lack of physical activity;
• diseases of the musculoskeletal system;
• vascular pathologies;
• deficiency of vitamins, microelements;
• stress: physiological, psychological, emotional stress;
• hypothermia;
• increased body temperature;
• obesity;
• genetic predisposition;
• injuries;
• pinching of nerve fibers.

Symptoms

With trismus of the jaw, partial or complete spasm of the temporal, medial pterygoid and masticatory muscles occurs. The main signs of this condition:

• inability to fully open the mouth;
• the occurrence of sharp pain when trying to unclench your teeth;
• tension, tightness and swelling of spasmodic muscles.

There are several degrees of trismus of the masticatory muscles:

• mild – the patient can open his mouth 3-4 cm;
• medium – the jaw unclenches by 1-2 cm;
• severe - the mouth opens 1 cm or less.

According to localization, trismus can be:

• unilateral - occurs only on the right or left side, usually appears with injuries and local inflammation;
• bilateral (symmetrical) – occurs in systemic diseases.

The spasm is accompanied by impaired speech and breathing. It also causes significant difficulties with eating.

Signs of involuntary muscle contraction are:

• with bruxism – grinding of teeth during sleep, a feeling of overexertion in the jaws after waking up;
• with spasms of the head muscles - hoop-shaped pain in the temples, in the forehead, in the back of the head;
• pressing, pulsating, squeezing nature of pain;
• feeling of heaviness in the area of ​​spasm;
• pain when pressing trigger points (try to palpate the area of ​​the head when it hurts: when you press certain points, the pain increases significantly);
• nausea, vomiting, dizziness;
• painful reaction to light, loud sounds (infrequently).

When to see a doctor:

• headaches appeared suddenly and do not go away;
• you are experiencing muscle pain for the first time after 50 years;
• pain is accompanied by dizziness, weakness, numbness of the limbs;
• pain lasts more than two weeks in a row;
• painkillers either do not work at all or give an insignificant short-term effect;
• the pain is localized on one side of the head/neck.

Muscle spasms that provoke pain indicate a disruption in the healthy functioning of the body. To prevent the development of the disease, it is important to consult a doctor in time. We advise you to visit a therapist, neurologist, endocrinologist, who will prescribe detailed laboratory diagnostics for you. Based on the research results, specialists of another profile may be involved in your treatment: an orthopedist, a cardiologist, a chiropractor. Complex treatment may include taking medications, a massage course, and therapeutic exercises. A good doctor will definitely give you recommendations on nutrition and daily routine.

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What can you do at home if:

Head muscle spasms

To relieve spasm and pain, you can take aspirin, a painkiller tablet like Ibuprofen, or a painkiller in powder form (for example, Nimesil). Give yourself peace of mind. You can try pressing trigger points and stretching your earlobes.

Jaw muscle spasm

If trismus manifests itself, before the doctor arrives, you can self-massage the masticatory muscles, accelerating the blood in them, alternately pressing on the muscles constrained by spasm. It is also possible to use compresses (alternate warm and cold compresses, apply them to the lower third of the face).

Cervical muscle spasms

Make gentle rotational movements with your head, lower and lift it (without throwing it back too much), turn it right and left. You can try stretching your neck muscles with your hands. Warm compresses and rubbing are effective.

*Attention! The information is for informational purposes only and does not constitute medical advice.

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What to do when clenching your teeth

In other cases, you should make an appointment with a doctor, and before that, at home, resort to the following measures:

Take a steroidal anti-inflammatory drug.

Ibuprofen or Naproxen will reduce joint inflammation and provide pain relief.

Apply a warm compress.

You can use a bottle filled with warm water. It is enough to apply it to the sore spot for half an hour: this will increase blood circulation and relieve spasms, and help relax the muscles.

Apply cold to the sore spot.

5-10 minutes after the warm compress, you need to cool the sore spot and relieve inflammation. Then it is again recommended to apply something warm.

Massage the chewing muscles and jaw joints.

Using the tips of your index and middle fingers, you need to feel the soft area on the cheeks in the lower jaw area and massage it for 30 seconds with light movements, without pressure. This will help the muscles relax.

Relieve stress and relax.

You can simply retire for 15 minutes and lie in silence, without thinking about anything. Yoga and meditation will help.

Drug treatment for muscle spasms

There is no universal remedy for muscle spasms of the head and neck. If the pain is episodic, taking painkillers in combination with supplementation with vitamins and minerals may be enough. If we are talking about chronic involuntary muscle contractions, the patient may be prescribed antiepileptic drugs, muscle relaxants, antidepressants, and antipsychotics. The doctor may also recommend medications to strengthen blood vessels and normalize blood circulation.

All patients with muscle pain are advised to ensure sufficient physical activity, avoid alcohol consumption, reduce stress levels, eat nutritiously and get enough sleep.