1/6. trismus in a 6 year old child: a manifestation of leukemia?trismus is a firm closing of the jaw due to tonic spasm of the muscles of mastication from disease or the motor branch of the trigeminal nerve. trismus may be produced by a variety of reasons such as dental abscess, trauma, following mandibular block with local anesthesia, as a result of radiation to the facial muscles, and patients after chemotherapy. A case of a referral of a six-year-old boy to a dentist from an ENT due to severe limitation in jaw opening is presented. Intraoral examination and panoramic radiograph demonstrated no signs of infection and/or other pathology. After a diagnosis of trismus was made, due to his icteric appearance, the general fatigue and loss of appetite in the last few days, palpated and sensitive lymph nodes in the submandibular and cervical regions, the child was referred for a complete blood count and sedimentation rate. The laboratory and clinical findings resulted in the diagnosis of acute lymphoblastic leukemia (ALL). Dental and oral manifestations of ALL are discussed, and the trismus may be explained by an intensive infiltration of leukemic cells into the deep portion of the contracting muscles of the face. This case emphasizes the importance of physical examination and independent judgement made by dentists, even when patients are referred to them by other members of the medical communities.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Surgical correction of trismus in a child with Hecht syndrome.Hecht syndrome is a rare condition that is also known as trismus pseudocamptodactyly syndrome. Short muscle and tendon units limiting the range of motion of upper and lower extremities and mouth characterize this disorder of muscle development. There is no consensus on the optimal treatment of temporomandibular joint (TMJ) ankylosis in this patient population. Endoscopic release in one patient resulted in early postoperative recurrence. The authors present a 28-month old boy who had a limited mouth opening of 6 mm. CT scan showed no bony ankylosis. The range of mouth opening did not to improve with physical therapy. The patient underwent extensive subperiosteal dissection of the mandible, bilateral coronoidectomy, and TMJ exploration. An intraoperative opening of 18 mm was achieved. The patient remained intubated until postoperative swelling resolved. He was extubated in the operating room 6 days later. The patient continued to improve with physical therapy. He had a 25-mm mouth opening at 12 months of follow-up.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
3/6. Post-traumatic severe trismus caused by impairment of the masticatory muscle.Restriction of the mouth opening from a pathologic condition outside the temporomandibular joint is called a pseudo- or extra-articular ankylosis. The authors report two cases of severe post-traumatic pseudoankylosis. One case showed fibrous degeneration of the bilateral masseter muscles without a facial bone fracture, which caused severe trismus, a mouth opening of less than 2 mm, and gradually appeared after blunt injuries to the face. The other was a rare case accompanied with the bone formation in the masseter muscle and was diagnosed as myositis ossificans traumatica, which also presented as severe trismus, with a maximal mouth opening of 5 mm after facial violence. Both were surgically treated with dissection of the affected muscles. In addition, a hemicoronoidotomy was performed in the case of myositis ossificans traumatica. Although a conservative therapy with physical rehabilitation is the basic policy for the management of pseudoankylosis of the temporomandibular joint, a surgical treatment should be considered when the origin of the problems is an osteogenic character or severe extra-articular ankylosis resistant to conservative therapy before completion of true temporomandibular joint ankylosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/6. Intraoperatively fabricated bite block in the management of scar contracture hypomobility.Intraoral surgical procedures produce scar tissue formation that may limit mandibular opening. Many procedures have been developed to release these scar contractures, but most lead to further scar formation and greater limitation in opening. The purpose of this article to describe a technique with the use of an intraoperatively fabricated self-curing acrylic bite block combined with aggressive physical therapy in the management of this difficult clinical problem.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. Nonmetallic foreign bodies of the skull base: a diagnostic challenge.Cases of physical trauma have become more common in emergency departments, since life in modern society has become increasingly dangerous. foreign bodies in the head and neck region are more common, therefore, and management principles are well-defined. Typically, these foreign bodies are metal, plastic, or glass and often easily diagnosed; however, wooden foreign bodies pose special problems for the physician and, therefore, warrant separate consideration. We present the case of a 21-year-old male who was stabbed in the submental region with a large wooden stake and discuss the surgical and follow-up treatment of this interesting case, including the roles and limitations of angiography, computerized tomography, and magnetic resonance imaging.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Sequelae of unrecognized, untreated mandibular condylar fractures in the pediatric patient.The mandibular condyle is a commonly involved site of maxillofacial trauma in children. However, this injury is often overlooked on initial physical examination in the emergency department. In cases involving blunt trauma to the chin it is important to suspect possible injury to the condyle of the mandible, as this type of facial injury can result in a spectrum of facial growth disturbances during the patient's later years. general practitioners and pediatric dentists are often the first clinicians to recognize the late complications of condylar trauma years after the injury. With a good clinical examination and past medical history, the diagnosis and etiology can be accurately determined. Once the diagnosis is made, the patient can be referred to a specialist involved in managing this type of problem. Three case reports of patients with facial deformity are presented.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |