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BACKGROUND AND OBJECTIVES: Extraction of impacted third molars is one of the most common oral surgeries performed in the dental clinic, which is often accompanied by many complications such as edema and trismus. Many methods have been used to alleviate these complications, such as drugs or physical therapy. Kinesiotape (KT) has recently spread as a popular physical method for eliminating complications after surgical extraction of lower third molars after its long-term use in sports medicine and injuries of the musculoskeletal system. The current study aimed to study the effect of using KT (Kinesio® Holding Corporation, Albuquerque, NM, USA) on both edema and trismus after impacted third molar extraction. METHODOLOGY: This study was designed as a randomized controlled clinical trial using the split-mouth technique and included 25 patients with radiographically symmetrical lower third molars from patients. All surgical extractions were performed by a single surgeon under sterile conditions according to the standard surgical protocol after that one group applied KT and the other group applied cryotherapy. Edema and trismus were measured in the first five days. Data was collected and analyzed by SPSS software (IBM Corp., Armonk, NY, USA). RESULTS: The mean change in the total linear facial measurements in the experimental group (Kinesio Group) was 12.32 mm three days after surgery, and then this value decreased to 6.80 mm, while the average increase in the control group (Cryo Group) was 17.00 mm after three days, then the value decreased to 9.68 mm five days after surgery. Regarding the changes in the amount of maximum mouth opening after surgery, the results were similar between the Kinesio Group and the Cryo Group, as there were no significant differences between the two groups (P<0.05). CONCLUSION: This study concluded that KT was superior to cryotherapy when studying edema. The current study also concluded that the mouth opening was similar between the two study groups.

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Aim: To compare the impact of submucosal dexamethasone (4 mg) administered after the onset of local anesthesia on postoperative discomfort after third molar surgery and compare the parameters with a control group that did not receive the drug. Methods: A total of 60 patients indicated for surgical removal of impacted mandibular third molars (mesioangular, Class II or III, and position B or C) were randomly divided into two groups of 30 patients each. After the onset of local anesthesia, the first group (Group A) received a submucosal injection of 4 mg dexamethasone adjacent to the surgical site, and the control group (Group B) received no drug. Pain, swelling, and trismus were recorded at follow-up visits on the 1st, 2nd, and 7th postoperative days. Assessment of postoperative discomfort was performed by evaluating responses through a modified postoperative symptom severity scale questionnaire, which was administered to the patients on the 7th postoperative day. Results: The difference in subjective pain values and the mean number of analgesics consumed was not significant between the groups. The difference in postoperative swelling was statistically significant on the 1st, 2nd (P < 0.0001), and 7th postoperative days (P = 0.0152). The difference in postoperative trismus was highly significant on 1st and 2nd postoperative days (P < 0.0001). The difference in the mean total quality of life (QOL) score, Eating, Appearance, Daily activity subscale (P < 0.0001), and Social Isolation subscale (P = 0.0002) was statistically significant between both groups. Conclusion: It was found that the administration of submucosal dexamethasone resulted in significantly lesser postoperative swelling and trismus and better QOL outcomes.

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BACKGROUND-OBJECTIVE(S): This randomized, split-mouth study aimed to compare postoperative complications following the surgical extraction of impacted lower third molars using piezosurgery versus conventional rotary instruments. MATERIALS AND METHODS: Twenty-one patients, aged 18-35 years, with bilaterally and symmetrically impacted lower third molars, were randomly assigned to undergo extraction using piezosurgery on one side and conventional rotary instruments on the other. RESULTS: The piezosurgery method required a longer operation time. However, it resulted in quicker resolution of postoperative swelling by the 7th day compared to the conventional method, where swelling persisted longer. Mandibular angle-tragus measurements were significantly higher with the conventional method on the 1st, 3rd, and 7th postoperative days. Although mouth opening decreased significantly after piezosurgery, it returned to preoperative levels by the 7th day, outperforming the conventional method. Postoperative pain was notably higher with the conventional method during the first four days but showed no significant difference from the 5th day onward. Alveolar bone healing was significantly better with piezosurgery at the 3rd and 6th months. Temporary paresthesia occurred in one patient from the conventional group, resolving within four weeks. Neither method resulted in alveolar osteitis. CONCLUSION(S): Within the study's limitations, piezosurgery demonstrated a reduction in postoperative discomfort, suggesting its advantage in enhancing patient recovery following lower third molar extractions. CLINICAL SIGNIFICANCE: Piezosurgery, when used appropriately, can reduce postoperative complications compared to conventional methods. Clinicians should be aware of its indications, benefits, and potential challenges. Trial registration This study was registered as a clinical trial to the ClinicalTrials.gov, and the registration ID is NCT06262841 ( https://clinicaltrials.gov/study/NCT06262841 ).

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OBJECTIVE: To describe the presentation, clinical findings, diagnosis, treatment, and outcome of cases of trismus (lockjaw) in cold-stunned sea turtles. ANIMALS: 4 Kemp's ridley (Lepidochelys kempii) and 1 loggerhead (Caretta caretta) sea turtle. METHODS: Cold-stunned sea turtles that presented with difficulty or inability to open their jaw between 2009 and 2023 were included. Information retrieved from medical records included signalment, physical exam findings, diagnostic information, definitive diagnosis via either advanced imaging or histopathology, treatment, and clinical outcome. RESULTS: Turtles presented between 4 and 48 days into rehabilitation. Three were diagnosed by advanced imaging (CT or MRI), and 2 were diagnosed based on clinical signs and postmortem histopathology. Treatment was multimodal and consisted of antibiotics (5/5), nonsteroidal anti-inflammatories (5/5), vitamin E (3/5), intralesional steroid therapy (3/5), acupuncture (3/5), antifungals (2/5), anti-inflammatory parenteral steroids (2/5), physical therapy (2/5), therapeutic laser (2/5), and supportive feeding via either total parenteral nutrition (1/5), or tube feedings (2/5). Two animals were released, 2 died naturally, and 1 was euthanized. CLINICAL RELEVANCE: Trismus (lockjaw) is an uncommon finding in stranded cold-stunned sea turtles that can have a significant impact on animal welfare if not diagnosed and treated. This report describes the condition to aid clinical case management and resource allocation in rehabilitation facilities.

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Bilateral trismus associated with oral cancer was commonly occurred in those who had received surgical intervention and radiotherapy. Complete release of bilateral fibrotic tissues followed by free flaps reconstruction was the main current surgical intervention. However, reconstructions of both defects mostly needed to harvest two flaps from different donor sites were time-consuming and increasing morbidities. Herein, we presented three cases who undergone modified reconstructive method by harvesting the anterolateral thigh (ALT) flap and tensor fascia latae (TFL) flap simultaneously from the same donor site. Trismus release was performed including resection of the buccal part and fibrotic tissue, myotomy of the masticatory and medial pterygoid muscles, and bilateral coronoidectomy. Case 1, a 52 years-old man, with severe trismus as the interincisal distance (IID) was about 0 mm. He undergone a combined 12 × 7.5 cm ALT and 11 × 6 cm TFL flap reconstruction from a single-donor thigh. The IID apparently increased to 37 mm after 1-year follow-up. Case 2, a 64 years-old man, went through a combination of 6 × 7 cm ALT and 6 × 6 cm TFL flap reconstruction from unilateral thigh for severe trismus. The IID significantly improved from 10 mm to 30 mm after one and a half-year follow-up. Case 3, a 53 years-old woman, with IID was around 0 mm before the surgery. A combined 9 × 3 cm ALT and 9 × 3 cm TFL flap reconstruction was performed as the IID enhanced to 20 mm after 6 months follow-up. This reconstruction method using ALT and TFL flaps harvested from a single-donor thigh simultaneously could be suitable for patients with bilateral severe trismus.

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Background/Objectives: Glucocorticoids are drugs that are increasingly used in oral surgery to reduce trismus, inflammation, and postoperative pain, three frequent complications after the surgical extraction of impacted lower third molars. The aim of this study was to compare the effect of 8 mg dexamethasone versus 40 mg methylprednisolone in the prevention of postoperative complications after third molar surgery. Methods: A randomized double-blind clinical trial was conducted following CONSORT guidelines. In detail, 84 patients were included in the study, who randomly received a single preoperative submucosal dose of dexamethasone (8 mg) or methylprednisolone (40 mg). The variables analyzed, as primary outcomes, were trismus, inflammation, and postoperative pain. The measurements were performed at baseline (0 h), 3 h, 7 h, 24 h, 48 h, and 7 th day using a Visual Analog Scale (VAS), Verbal Rating Scale (VRS), and the Gabka-Matsumara method. Results: Dexamethasone reduced trismus, inflammation, and postoperative pain significantly better than methylprednisolone. Conclusions: Preoperative submucosal administration of 8 mg dexamethasone is effective and safe in reducing the severity of postoperative complications following surgical extraction of impacted lower third molars.

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INTRODUCTION: Trismus is a potentially critical morbidity following curative-intended radiotherapy in head and neck cancer patients. However, in this setting, evidence regarding this side effect remains to be fully defined, particularly in terms of dosimetric parameters. MATERIALS AND METHODS: Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. RESULTS: This paper contains a narrative report and a critical discussion of the evidence on radiation-induced trismus in the literature, particularly the dosimetric concerns. CONCLUSIONS: The treatment goal should be to maintain high cure rates and limit the onset of complications. Further evaluations of dosimetric measures and clinical outcomes are warranted to identify patients at higher risk to target treatment tailoring.

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AIMS: To investigate how absorbed doses to mastication structures in modern radiotherapy (RT) technique for head and neck cancer (HNC) compared with earlier RT techniques and with published trismus tolerance doses. To compare the incidence of radiation-induced trismus by earlier and newer RT techniques. MATERIALS AND METHODS: This study investigated two HNC patient cohorts treated with RT in 2007-2012 (three-dimensional conformal radiotherapy [3DCRT] and/or intensity-modulated radiotherapy [IMRT]; n =121 [Cohort 1]) and 2017-2020 (volumetric-modulated arc therapy [VMAT]; n =124 [Cohort 2]). All patients underwent RT without mastication structure-sparing intent, had normal mouth-opening ability before RT, and were prospectively assessed. Trismus was defined as the maximal interincisal opening ≤35 mm at any follow-up (3-, 6-, and 12-months post-RT). The temporomandibular joints (TMJs), masseter, and medial/lateral pterygoid muscles were delineated on the planning CT:s. Mean doses were compared between cohorts, and evaluated with respect to published trismus tolerance doses. P values ≤ 0.05 indicated statistical significance. RESULTS: Within 12 months post RT, 74/121 (61%) of patients in Cohort 1 had experienced trismus compared to 11/124 (9%) in Cohort 2. Averaged mean doses (±S.D.) for the masseter muscles were 35.2±8.3 Gy in Cohort 1 and 20.2±8.7 Gy in Cohort 2 (P <0.001). Corresponding numbers were 19.1±16.2 and 4.3±4.3 Gy for the TMJs, 53.7±10.1 and 40.2±16.8 Gy for the medial pterygoid muscles, and 29.2±18.7 and 9.2±8.4 Gy for the lateral pterygoid muscles (all P <0.001). Masseter muscle doses were below tolerance doses in 23% of patients in Cohort 1 compared with 90% in Cohort 2. The corresponding numbers were 52% and 96% for the TMJs, 8% and 36% for the medial pterygoid muscles and 72% and 100% for the lateral pterygoid muscles. CONCLUSION: Mastication structure mean doses by more recent RT techniques were generally below proposed tolerance doses, with dose reductions of 10-20 Gy compared with earlier techniques. Modern RT without mastication-structure-sparing intent resulted in below 10% of HNC patients experiencing trismus compared with 60% treated with earlier techniques.

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We read the study conducted by Joseph and colleagues with great interest, which investigated the loco-regional control, disease-specific survival (DSS), overall survival (OS), and treatment-related complications in 163 oral cancer (OC) patients treated with radiotherapy (RT) or chemo-RT (CRT) for close resection margins (CRMs).The study results offer valuable insights into the role of RT/CRT in OC patients with CRMs, but two concerns must be addressed to interpret the outcomes rigorously.

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Background and Objectives: The aim of this study was to investigate the efficacy of a single preoperative dose of deflazacort on pain, swelling, and trismus after impacted lower third molar surgery. Materials and Methods: This randomised, prospective, double-blind, split-mouth clinical study included 26 healthy individuals with bilaterally impacted lower third molars. Group 1 was given a placebo (single-dose vitamin C tablet), and group 2 was given a single 30 mg dose of deflazacort 1 h prior to surgery. Pain was evaluated using the visual analogue scale for 1 week postoperatively. Oedema (in mm) and trismus (in mm) were evaluated preoperatively and on postoperative days 2 and 7. The Mann-Whitney U test was applied for group analyses. p values < 0.05 were considered statistically significant. Results: Postoperative pain scores were significantly lower in the deflazacort group at the 6th and 12th hours after surgery (p < 0.05). There were no significant differences in trismus between the groups at any time point (p > 0.05). There was less oedema in the deflazacort group on postoperative days 2 and 7, without any statistically significant difference (p > 0.05). Conclusions: A single preoperative dose of 30 mg deflazacort was found to be clinically effective in reducing pain and oedema after extraction of impacted lower third molars.

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BACKGROUND: Trismus therapy is often delayed after jaw reconstruction to avoid hardware failure or non-union. The aim of this study is to document the forces that have been applied to patients undergoing free flap reconstruction of the oral cavity in the 12 months following oral cavity reconstruction, and to analyze the associations between force and maximal interincisal opening (MIO) over time. METHODS: Participants with trismus after free flap reconstruction of the oral cavity completed a 10-week jaw stretching program using Restorabite™. Primary outcome measures included the minimum and maximal force applied by a trismus device during rehabilitation, MIO, bone union, and health-related quality of life outcomes up to 12 months postoperatively. RESULTS: A mean of 20.6 Newtons (N) was used during passive exercises and 38.9 N during active exercises was used during trismus therapy. The mean increase in MIO for the 45 participants after 10 weeks, 6 months, and 12 months of therapy was 8.4 mm (p < 0.001), 12.6 mm (p < 0.001), 12.7 mm (p < 0.001), respectively. There was no significant difference in the mean minimal (p = 0.37) or mean maximal (p = 0.08) force applied between those who underwent osseous free flap reconstruction compared to fasciocutaneous only, respectively. In patients who underwent osseous reconstruction, 25 (67.6%) had complete bone union and 12 (32.4%) had partial union at 12 months postsurgery. CONCLUSIONS: In participants undergoing osseous free flap reconstruction, there was no association between the force applied to the rates of bone union. Further research to define safe and optimal loading may benefit patients undergoing jaw reconstruction.

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BACKGROUND: Oral Submucous Fibrosis, OSF is an inflammatory mucosal disorder prevalent in areca nut chewing belts of the world. Although various treatments are available for its management, none provide complete resolution.Curcumin, an indigenous product, improves burning sensation, mouth opening along with other clinical signs of OSF and is potentially viable therapeutic option for its management. OBJECTIVES: To assess the available evidence for employing curcumin in improving symptoms in patients with OSF. METHODS: Systematic search was carried out in e-databases from January 2010 until July 2023 to identify relevant clinical trials comparing curcumin to active and/or nonactive controls (placebo) for the management of OSF. RESULTS: A total of 20 studies were used for qualitative analysis out of which 11 studies were considered for quantitative synthesis.Curcumin was found to be highly effective in alleviating pain/burning sensation, improving mouth opening (MO), cheek flexibility, tongue protrusion and induces positive histological changes in patients with OSF.The standardized mean difference in mouth opening between both the Curcumin and Multivitamin group showed a statistically significant difference favouring the Curcumin group (SMD, 0.37, 95% CI = 0.18-0.56, p - 0.0001, I2- 0%). CONCLUSION: Statistically curcumin was noted to be as effective as Aloe vera, lycopene and steroids in relieving symptoms of OSF in stages 1 and 2 and improving MO. It is seen to improve histopathological picture of lesions thereby suggesting its active role in preventing malignant transformation. Its found to be more effective than multivitamins in improving mouth opening of patients in OSF.

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PURPOSE: This study aimed to compare the effects of a mobile health intervention based on social cognitive theory with standard care on maximal mouth opening, exercise compliance, and self-efficacy in patients receiving proton and heavy ion therapy for head and neck cancer. METHODS: This open-label, parallel-group, randomized, superiority trial involved a self-developed "Health Enjoy System" intervention. We assessed maximal mouth opening, exercise compliance, and self-efficacy at baseline (T0), post-treatment (T1), and at 1 month (T2) and 3 months (T3) after radiotherapy. Generalized estimating equations were used to analyze differences between the groups over time, with results reported as P values and 95% confidence intervals (CIs). RESULTS: The study included 44 participants. At T3, the intervention group showed a 6 mm greater increase in maximal interincisal opening than the control group (mean difference = 6.0, 95% CI = 2.4 to 9.5, P = 0.001). There was also a significant difference in exercise compliance between the groups (mean difference = 31.7, 95% CI = 4.6 to 58.8, P = 0.022). However, no significant difference in self-efficacy was found between the groups. CONCLUSION: This study demonstrated that an mHealth intervention incorporating behavior change theory could effectively enhance or maintain maximal mouth opening in patients undergoing proton and heavy ion therapy for head and neck cancer in China. This approach provides valuable support during and after treatment. TRIAL REGISTRATION: ChiCTR: ChiCTR2300067550. Registered 11 Jan 2023.

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In this study, we describe the role of ultrasound in diagnosing pediatric peritonsillar abscesses (PTAs). A retrospective chart review was conducted on 54 children aged 4 to 17 years who had an ultrasound performed for suspected PTA. Based on ultrasound imaging, the patients were classified into 2 groups: PTA-positive (8, 14.8%) and PTA-negative (46, 85.2 %). Trismus was significantly associated with PTA (50% vs. 13%, P = .03). PTA-positive patients were more likely to be given steroids, be admitted, and have extended hospital stays (P = .04, .004, and .002, respectively). The 2 groups had no significant difference in computed tomography (CT) acquisition, surgical intervention, and return visits (P = .92, .17, and .97, respectively). Larger abscesses trended toward surgical treatment (P = .087). Ultrasound is an efficient diagnostic modality for suspected peritonsillar infections in children, with similar clinical outcomes for PTA-positive and PTA-negative groups.

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Pathological diagnosis plays a pivotal role in risk classification and personalized treatment planning for patients with oropharyngeal cancers. However, challenges arise in cases involving trismus and tumors with submucosal spread, hindering traditional endoscopic biopsies and open incisional biopsies. In this study, we examined the clinical and pathological data of patients with trismus who underwent transoral ultrasound-guided core biopsy (USCB) for their oropharyngeal tumors, comparing this method with existing diagnostic approaches. Seventeen patients presenting with oropharyngeal tumors and trismus underwent transoral USCB for diagnosis. Of these, 14 patients were diagnosed with squamous cell carcinoma, while the remaining 3 were diagnosed with lymphoma. The procedure resulted in minimal wound size and effective bleeding control through compression, without encountering any complications. In conclusion, transoral USCB emerges as a precise diagnostic tool for patients with oropharyngeal tumors and trismus, offering a valuable adjunct to conventional open and endoscopic biopsies.

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Understanding the barriers and facilitators for prophylactic swallowing and trismus exercises for patients undergoing radiation to the head and neck may help exercise adherence. The analysis reviews all published reports of exercise adherence with a critical appraisal following PRISMA guidelines. A total of 137 potential papers were identified; 20 studies met the inclusion criteria. The most commonly reported facilitators for swallowing and trismus exercises were regular clinician contact and online resources to reinforce instructions, set goals, and manage radiation toxicities. Social support and perceived benefit from exercises were also reported to be of help. The most common barriers to exercise were radiation toxicities, anxiety, feeling overwhelmed with information, and not understanding the reason for the exercises. Understanding facilitators and barriers to adherence is critical when designing exercise interventions for patients undergoing radiation for head and neck cancer.

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Throat packing is essential in oral and maxillofacial surgeries to prevent blood and tissue debris aspiration, reducing postoperative complications. Traditional oral route methods are often inadequate, especially in severe trismus cases like Oral Submucous Fibrosis (OSMF), TMJ Ankylosis, and post-traumatic conditions due to limited mouth opening. This study introduces a novel technique using a nasopharyngeal airway (NPA) for throat packing. The method involves inserting a hemostatic dressing through an NPA, ensuring minimal invasiveness and effective airway management. Proper positioning is confirmed with a laryngoscope or fiberoptic scope, and the dressing is secured to prevent dislodgement. This technique is easy, reproducible, and less injurious compared to traditional methods. At our center, throat packing via NPA was performed on 35 patients undergoing surgery under general anesthesia, resulting in high satisfaction and no reported complications.

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BACKGROUND: Isaacs' syndrome, also known as neuromyotonia or peripheral nerve hyperexcitability, is a rare disorder that affects the peripheral nervous system. Clinical findings include cramps, fasciculations, and myokymia; however, there are few reports of dental treatment for trismus. CASE PRESENTATION: A patient with trismus due to Isaacs' syndrome experienced swelling and pain in the gingiva surrounding his right lower first molar. He was diagnosed with chronic apical periodontitis by a dentist near his home. However, the patient was informed that dental treatment and medication could not be administered because of the presence of Isaacs' syndrome, and he visited the Geriatric Dentistry and Perioperative Oral Care Center at Kyushu University Hospital 2 weeks later. The patient's painless mouth-opening distance (between incisors) was 20 mm at that time, and medication, including amoxicillin capsules and acetaminophen, was administered because the dental extraction forceps or endodontic instruments were difficult to insert into the oral cavity for treatment. Two months after his initial visit, the patient visited us complaining of pain in the same area. However, he had recently undergone plasmapheresis treatment in neurology to alleviate limited mouth opening and systemic myalgia, resulting in a pain-free mouth-opening distance of approximately 35 mm. During this temporary period in which he had no restriction in mouth opening, we performed tooth extraction and bridge restoration on the mandibular right first molar and created an oral appliance for sleep bruxism. CONCLUSIONS: Plasmapheresis therapy transiently reduced trismus, rendering dental interventions feasible, albeit temporarily. This case report underscores the importance of close collaboration between neurologists and dentists who encounter similar cases while furnishing valuable insights to inform dental treatment planning.

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Clinicians should consider disorders of masticatory muscle including lateral pterygoid muscle as a differential diagnosis in patients presenting with dysphagia and trismus after tooth extraction.

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Introduction Lower third molar impaction surgery is one of the most common minor oral surgical procedures done. Trismus has been one of the most common and disturbing postoperative sequelae for patients. The study aimed to evaluate the electrical activity of the masseter and temporalis muscles after mandibular third molar surgery. Materials and methods The research was conducted at Saveetha Dental College and hospitals in the Department of Oral and Maxillofacial Surgery. The study consisted of 20 individuals. The EMG (electromyography) activities of both masseter muscles in each patient were measured before the tooth extraction surgery, postoperatively after 72 hours, and after seven days. The inter-incisal distance was also measured at similar follow-up intervals. Data were analyzed using IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp., with p-values less than 0.05 considered statistically significant. The Mann-Whitney U test was used for the comparison of electrical activity between masseter and temporalis on both the operated and non-operated sides during preoperative, postoperative, 72-hour, and postoperative seven-day periods. Results It has been found that the electrical activity of the temporalis is higher than that of the masseter muscle measured at all the intervals of the follow-up period, with statistically significant values (p=0.001). It was noted that all the patients have reduced mouth opening when compared with preoperative (mean mouth opening = 45.6 mm), postoperative 72 hours (mean mouth opening = 31.2 mm), and postoperative seven days (mean mouth opening =35.6 mm). When a comparison was done between temporalis and masseter, the masseter took longer to return to pre-operative electrical activity, which might also imply that for prolonged trismus seen in patients after lower third molar surgery, it is the masseter that is affected and needs recovery for trismus to be resolved.  Conclusion  Based on the results obtained, it can be concluded that there was a reduction in the electrical activity of both the masseter and temporalis post-third molar impaction surgery. It was also found that there was a reduction in mouth opening in patients who underwent lower third molar extraction surgery. Masseter muscle took longer to return to its preoperative electrical activity than temporalis muscle, implying that targeted therapies to accelerate the healing of masseter muscle may prevent prolonged trismus in patients who undergo lower third molar impaction surgery.