Longterm trismus after extraction

[molarprep]

Anyone with similar experience, please let me know your thoughts;

A patient has trismus (opening of ~5mm) after an easy lower 1st molar extraction (2min. to finish, starting from local anesthesia onset) done 2 weeks ago. 2 weeks seems like a long time to me - should there be any other follow-up care other than the usual muscle relaxants and warm compress?

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[Contach]

What type/dosage of muscle relaxants are you prescribing?

When did the symptoms of 'trismus' start?

You can suggest some physical therapy techniques: using fingers to pry jaw open within reasonable discomfort threshold (ie. no pain).

 

[molarprep]

What type/dosage of muscle relaxants are you prescribing?

When did the symptoms of 'trismus' start?

You can suggest some physical therapy techniques: using fingers to pry jaw open within reasonable discomfort threshold (ie. no pain).

Trismus started a day after the extraction...and I've prescribed the robax med (methocarbamol 500mg and ibuprofen 200mg)

 

[UncUndergrad1]

How did the extraction go
Any history of TMJ issues
Patient health conditions
Did you use a biteblock
Do you think you might have placed anesthesia in the muscles/parotid -- was it something besides lido

Need more details bro, can't fix a problem if you don't know its etiology

 

[OUOMS]

Anyone with similar experience, please let me know your thoughts;

A patient has trismus (opening of ~5mm) after an easy lower 1st molar extraction (2min. to finish, starting from local anesthesia onset) done 2 weeks ago. 2 weeks seems like a long time to me - should there be any other follow-up care other than the usual muscle relaxants and warm compress?

Refer to an OMS for a CT scan. Very similar case at my training program. Guy ended up with myositis ossificans of the medial pterygoid after IAN injection and extraction #30 that was as atraumatic as it could possibly be. Basically calcified the muscle causing trismus. It's extremely rare, but it's possible if guy shows no improvement over a few more weeks.

Best of luck and keep us updated.

 

[justsusan]

it sounds like total anterior disk displacement..read this

http://halligantmj.com/the-closed-lock/

 

[molarprep]

Thanks everyone for the feedback. I have spoken with the patient and he seems to be getting better - I will observe for another week and hope for more improvement - otherwise, I will refer for CT scan. I am suspecting if it could have to do with the 25 gauge needle (I have just recently made the switch from 27 gauge, as they offer better control with less needle deflection) - literature reports no difference between 25 & 27 gauge in terms of pain, but I have recently had another patient reporting trismus after I started using the 25 for giving nerve blocks.

 

[justsusan]

2 weeks is a long time. send him to OMFS. you're not helping him by waiting.

 

[murtada]

I dont think its related to gauge sizes rather than inserting the needle where you probably hit the pterygoid muscle. update us please with the current condition and how long does it take your patient to be completely/partially good.

 

[molarprep]

one patient is completely fine now
another patient's opening is pretty much at the same level as prior to exo, but because the patient was still feeling discomfort, I referred to OMFS for further assessment a few weeks ago.