What is Trismus?

What is Trismus?

What is Trismus?

Trismus is a general term used to describe a person experiencing difficulty opening their mouth. The causes of Trismus are very diverse. Most commonly it occurs as a secondary effect of another medical condition, or as an unavoidable side effect of other necessary clinical procedures including;

• Radiotherapy to the head and neck
• Head and neck surgery

Trismus can be a very debilitating condition that can really affect a person’s quality of life. Someone suffering from Trismus will experience a tightening of the jaw. For some this will be coupled with various degrees of discomfort and pain. Not being able to open your mouth properly can restrict a person’s ability speak, chew and swallow. It can also prevent them from cleaning their teeth effectively, leading to further oral and dental problems.

Anybody who thinks they might have a limited mouth opening should discuss their concerns with one of their medical advisors. It is possible to perform a basic self-test called the ‘3 Finger Test’. This simple test is not a diagnostic tool. Anyone believing that they might be suffering from Trismus should always seek the advice of a qualified medical professional.

The 3 Finger Test

A quick and easy way to identify a possible case of Trismus is to place three of your fingers, stacked, between your upper and lower teeth, or dentures. If the mouth can open wide enough to accommodate them comfortably, then Trismus is unlikely to be a problem. If not, this may indicate Trismus or its development that should be further investigated by a clinician.

Range of Motion Scales

The result of the 3 Finger Test can be easily confirmed by measuring a person’s Maximal Incisal Opening (MIO) with the use of the TheraBite range of motion scale.

This simple scale is placed between the central incisors, enabling your mouth opening to be officially measured.

Anything below the mid 30 range (mm) may indicate Trismus.

Once confirmed by a clinician a treatment pathway can be tailored to the individual’s needs.

Keep your jaw muscles relaxed during all massage and exercises. Avoid clenching your jaw when you are stressed or out of habit.

If you are in discomfort, please take your recommended pain killers 20-30 minutes prior to exercises to aid comfort and success.

1. Maintain good posture.
   Neck stiffness can affect posture, shoulder movement and can cause pain, all of which can impact on jaw opening and upper body tension.
   Carry out regular neck exercises given to you by your physiotherapist following surgery.  Your GP can refer you to a physiotherapist if needed
2. Heat packs
   Place a moist warm flannel, a warm hot water bottle or a heated wheat bag on the affected area for 15-20 mins x2-3 a day. Heat therapy improves elasticity of the collagen fibres in your muscles affected by surgery and radiation. It can help with stiffness and pain. Do this prior to any jaw exercises. Please ensure you use an appropriate amount of heat which is comfortable and does cause trauma to the skin.
3. Massage
   Place your index and middle finger on your cheek bone. Run your fingers down over your jaw muscle, which ends at your bottom jaw. As you move your fingers, find points that feel tender or tight. Massage these areas with your fingers in a circular direction for 30 seconds. Do this 2 to 3 times a day. Keep your jaw relaxed.

Passive stretching exercises:
(Practise 3-5 times daily)

1. a. Open the jaw as far as possible.
   b. Keep open in this position for 30 seconds (if necessary with the use of tongue depressors).
   c. Slowly close the mouth.

2. a. Move the jaw as far as possible to the right (stretch but not painful).
   b. Keep in this position for 30 seconds.
   c. Relax

3. a. Move the jaw as far as possible to the left (stretch but not painful).
   b. Keep in this position for 30 seconds.
   c. Relax.

4. a. Make a circular movement with the jaw (stretch but not painful).
   b. Relax after completing one circle

If you continue to experience difficulties with jaw opening, your Speech Therapist may recommend an intensive therapy course using a TheraBite. This would be under the supervision of your Doctor. If you have any questions in relation to this please discuss with your Speech Therapist.

Log:

Date	Jaw opening

If you require further assistance, please contact Speech and Language Therapy on; 01905 760475

Or

Adult Speech and Language Therapy Acute Services
Level 1, Aconbury West, Charles Hastings Way
Worcester Royal Hospital
Worcester
WR5 1DD

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.  

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