From the Guidelines
Temporomandibular joint (TMJ) disorder causing lockjaw, or trismus, should be treated with conservative approaches first, including reassurance and education, avoidance of wide mouth opening or aggravating activities, soft diet, jaw exercises, massage, non-steroidal anti-inflammatory drugs (NSAIDs), heat and/or cold, bite plate in the presence of bruxism, physiotherapy, mindfulness, yoga, meditation, acupuncture, splint therapy, cognitive behavioural therapy, paracetamol, and neuromodulatory medications (eg, amitriptyline, gabapentin) as recommended by the most recent guidelines 1.
Treatment Options
- Conservative approaches:
- Reassurance and education
- Avoidance of wide mouth opening or aggravating activities
- Soft diet
- Jaw exercises
- Massage
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Heat and/or cold
- Bite plate in the presence of bruxism
- Physiotherapy
- Mindfulness
- Yoga
- Meditation
- Acupuncture
- Splint therapy
- Cognitive behavioural therapy
- Paracetamol
- Neuromodulatory medications (eg, amitriptyline, gabapentin)
- Surgery should be considered only after non-response to conservative therapy, including arthrocentesis, arthroscopy, or open surgery of the temporomandibular joint 1.
Importance of Conservative Approaches
Conservative approaches are recommended as the first line of treatment for TMJ disorder causing lockjaw, as they are reversible, safe, and of low cost in most healthcare settings 1. These approaches can help improve symptoms and dysfunction, and can be used in conjunction with other treatments such as oral splints and physiotherapy.
Role of Surgery
Surgery should only be considered after non-response to conservative therapy, as it is associated with more risks and complications 1. The decision to proceed with surgery should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances.
Additional Considerations
- Maintenance of range of motion is important to prevent trismus, and can be achieved through tongue blades and gentle stretching, as well as custom mouth opening devices for rehabilitation of trismus and jaw motion 1.
- Patient education and reassurance are crucial in the management of TMJ disorder causing lockjaw, as they can help reduce anxiety and improve adherence to treatment plans.
From the Research
Treatment of Temporomandibular Joint (TMJ) Disorder Causing Lockjaw (Trismus)
There are no research papers provided that directly address the treatment of temporomandibular joint (TMJ) disorder causing lockjaw, also known as trismus. However, the provided studies discuss the treatment of tetanus, which can cause trismus.
Treatment of Trismus Caused by Tetanus
- The treatment of tetanus involves removal of the offending organism, neutralization of free neurotoxin, controlling rigidity and reflex spasm, and minimizing complications 2.
- Diazepam may be used alone in mild cases of tetanus to control muscle spasms and rigidity 2, 3.
- In severe cases of tetanus, the addition of nondepolarizing neuromuscular blocking agents and mechanical ventilation may be required 4, 2.
- Benzodiazepines, such as diazepam, are the drug of choice for treating spasm and rigidity in tetanus, and large doses may be required to overcome the spasm 5.
- Magnesium sulphate has been used to treat both spasms and autonomic dysfunction in tetanus, but its efficacy and safety are not well established 6.
Management of Trismus
- Trismus is a common symptom of tetanus, and its management is crucial to prevent complications such as aspiration and respiratory failure 4, 2.
- The use of nasogastric tube placement for feeding and medications may be necessary in patients with trismus 4.
- Early elective tracheostomy may be performed in moderate or severe tetanus to prevent aspiration and laryngeal stridor 4.