Problems With Trismus

Simple Tasks Become Difficult

Degradation of Joints and Muscles

Vicious Cycle of Trismus

Limited jaw mobility can cause difficulty in eating, speaking, cleaning teeth, yawning or even breathing. In head and neck cancer patients, these problems can arise at a time when nutrition, attitude, and oral hygiene can be very important to comfort and recovery.

Trismus can make it difficult to introduce food into the mouth and interferes with chewing and swallowing. Speaking can be difficult when the mouth cannot open sufficiently to create normal sounds.

Trismus also makes it more difficult to maintainoral hygiene at a time when it should be most meticulous. When the patient is unable to open sufficiently to brush teeth effectively, or apply fluoride trays, the risk for oral complications such as mucositis, dental caries, and tooth decay may increase significantly. Reduced oral hygiene is more than a minor inconvenience when common dental caries become extensive and have the potential to lead to serious conditions, e.g. osteonecrosis (bone tissue death) and osteoradionecrosis (bone tissue death due to radiation therapy). Oral assessment by dentists and oral intubation for general anesthesia becomes difficult and, at times, impossible.

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Psychosexual behavior may also be compromised, interfering with important relationships. Finally, trismus can lead to a reduced quality of life at a time when the patient is poorly prepared to face an additional problem. The inability to eat or speak properly, combined with the other difficulties related to surgery and radiation treatment, may be viewed as one more obstacle to a normal life. Discouragement, and even depression, resulting from such difficulties are not uncommon.

A serious consequence of trismus is its negative effects on jaw joints and muscles. These joints and muscles are vital for chewing and articulating. We engage our jaw joint - also called the temporomandibular joint or TMJ - in all jaw movements. As every joint, the TMJ is lubricated and equipped with anti-inflammatory properties when it moves through its range of motion. Absence of joint movement can lead to the onset of inflammatory agents, which cause joints to stiffen and gradually break down. Similarly, muscles that are not used regularly will more easily become weaker and fatigued.

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Vicious Cycle of Trismus

Trismus is actually just the tip of the iceberg. If not treated properly and promptly, trismus can trigger a negative spiral leading to further complications and detriment to quality of life.

Effects of trismus include:

• Inflamed jaw joints, leading to chronic pain
• Breakdown in the temporomandibular joints (TMJ)
• Weakened jaw/chewing muscles (atrophy)
• Tooth decay
• Osteoradionecrosis (ORN)
• Malnutrition
• Food entering the airway, leading to pneumonia
• Choking
• Poor post-surgical/radiation wound healing
• Difficulty in oral intubation

If you suffer from trismus, or are at risk of developing trismus, you should visit a qualified clinician to be evaluated and treated to prevent further restriction in jaw opening, chronic pain, and other complications.

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