Reasons Of Decreased Opening Of The Mouth And Treatment

by Gloria Philips Expert Blogger

Reduced mouth opening is a widespread health issue, and many people encounter it at least once in their lifetime, and most dental practitioners frequently see patients with reduced mouth opening. It can arise due to a number of underlying causes that may include complex variables. It is also necessary for the clinician to carefully evaluate and analyze these cases for proper diagnosis and effective management.

The problem of decreased opening of the mouth is caused for a number of causes. This specific clinical condition cannot be due to any particular illness or condition, since it can be a symptom of a variety of disorders. The opening of the mouth in stable people is about 30-50mm. But when the opening of the mouth is restricted to a maximum of 20mm, the person is said to have restricted opening of the mouth or trismus.

Five cases of decreased mouth opening have been identified, with rare etiological factors such as caustic soda ingestion, oral submucous fibrosis, space infection, temporomandibular joint ankylosis and zygomatic arch fracture and surgical management.

Cases of caustic soda ingestion and subsequent surgery have scarcely been reported in the literature. Many greasing materials are being tried in the restoration process. Skin graft has also been used by many surgeons in the past, but has not been known to be a common choice of graft material in such cases, due to dehiscence and further loss of skin graft and relapses, but in our case skin graft has been taken quite well. No complications have been reported even after 1 year of surgery. In this particular situation, the tongue was absolutely stuck to the floor of the mouth (no movement). The release of the tongue from the floor and the positioning of the grafting of the skin on the ventral side of the tongue provided an outstanding outcome with adequate mobility of the tongue.

OSMF is still a very popular disease particularly in developed countries, due to established reasons for chewing tobacco, pan, etc. Various medicinal and surgical treatments are recommended and performed, depending on the severity and duration of the disease. Our case was diagnosed as OSMF 10 years ago and all possible treatments including intralesional corticosteroid injection were administered, but the patient was not relieved of the disease. When she came to us, we suggested a surgical option for bilateral band resection, coronoidotomy and reconstruction, followed by vigorous physiotherapy with buccal pad fat grafting. Although it was a tough decision for the patient to be ready for this kind of surgery, she gave her consent and the result of buccal pad graft is also very encouraging.

Space infections can cause trismus; timely intervention in the form of incision and drainage is the key to such a situation.

Trismus and limited mouth openings range from nil to several centimetres in patients with temporomandibular ankylosis. The first objective was to ensure a sufficient opening of the mouth, and the second objective was to maintain this through physiotherapy. By osteoarthroplasty, we have achieved excellent results.

When depressed, the zygomatic arch fracture restrains the movement of the coronoid process and may cause temporary trismus. The zygomatic arch/bone sometimes unites with the process of coronation (malunited fracture). Patients are treated and corrected by refracting and opening the mouth of the arc and coronoid process.

Even though trismus cases are not quite often found in clinicians, and these cases sometimes seem to be difficult to diagnose, you can treat them very efficiently if you take a correct history and do a careful clinical examination and research.

We have met a few trismus cases with different etiologies. However, each of them received treatment according to the underlying cause.

Conclusions Conclusions

Although cases of trismus initially appears difficult, we can offer the appropriate treatment for patients with a good pronouncement by proper diagnosis and planning. Skin grafts remain a good reconstructive option for soft tissues and the fat buccal pad is an excellent alternative because of its proximity in oral and maxillofacial cases.

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