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When Trismus Therapy is Not Recommended

"You can't win 'em all" is a common phrase in American culture. This phrase, unfortunately, holds true for trismus patients with certain etiologies, such as stroke, cerebral palsy, TMJ ankylosis, dental infections, Myofascial Pain Syndrome, congenital trismus, non-odontogenic infections (such as tetanus and meningitis), and oral submucous fibrosis (not the same as radiation fibrosis). These etiologies entail different pathophysiologies of trismus that, rather than exercise-based trismus therapy, respond better to pharmacology (Botox, for example) or surgery. Knowing when trismus therapy is not recommended and which patients are better candidates for Botox and surgery will prevent clinicians from wasting valuable patient time and unnecessary healthcare resources. 

Spastic hypertonia is a common sequelae after a cerebrovascular accidents (CVAs) and traumatic brain injuries (TBIs) that involve upper motor neuron (UMN) lesions. Spastic hypertonia is also a symptom of multiple sclerosis and cerebral palsy. As a review, an UMN lesion is any injury affecting the neural pathway above the anterior horn cell of the spinal cord or the motor nuclei of the cranial nerves. In contrast, lower motor neuron lesions affect the nerve fibers traveling from the anterior horn cell of the spinal cord to the muscles. The pathophysiology of UMN lesion spasticity is not completely understood, but current research indicates spasticity results when there is a change in the balance of excitatory and inhibitory inputs to the motor neuron pool. For UMN lesion damaged patients, exercise-based trismus therapy is not a recommended treatment approach.

In a 2009 placebo-controlled, randomized study on patients with spastic trismus as a result of UMN lesion CVA or TBI, Botox injections showed significant increases in mouth opening compared with the placebo treatment (Fietzek, Kossmehl, Barthels et al, 2009). Botox, or botulinum toxin, is a neurotoxic drug, which means it inhibits nerve contraction signals to the muscles. Botox acts by blocking neuromuscular transmission via inhibiting acetylcholine release (Ozcakir and Sivrioglu, 2007). If a SLP encounters a patient with UMN lesion-related trismus, he or she should refer the patient to an ENT or Oral and Maxillofacial Surgeon instead of pursuing exercise-based trismus therapy.

The following is a list of other etiologies of trismus that respond best to surgery or medication, rather than speech therapy. SLPs should defer to other medical professionals for these kinds of trismus.
  • Patients with congenital trismus should be treated by oral and maxillofacial surgeons
  • Patients with TMJ Ankylosis should be treated by oral and maxillofacial surgeons
  • Patients with dental infections should be treated by dentists
  • Patients with on-odontogenic infections, such as tetanus, should be treated by physicians
  • Patients with Myofascial Pain Syndrome should be treated by oral and maxillofacial surgeons or physiatrists specializing in pain management 


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Visit our course homepage and submit your trivia answer today! 
Congratulations to
The 2016 ARK-J Program Graduate SLP Student Partial Scholarship Recipients!
Laurabeth Arvison
Courtney Bahl
Mallison Fisher
Orlando Hinojosa
​Jasmine Cristoff
Michelle Krahenbuhl
​Madison Light
Haley Reiff
Angelina Schache
Amber Simonton
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