Trismus originating from rare fungal myositis in pterygoid muscles:A case report

BACKGROUND Trismus is a common problem with various causes.Any abnormal conditions of relevant anatomic structures that disturb the free movement of the jaw might provoke trismus.Trismus has a detrimental effect on the quality of life.The outcome of this abnormality is critically dependent on timely diagnosis and treatment,and it is difficult to identify the true origin in some cases.We present a rare case of trismus due to fungal myositis in the pterygoid muscle,excluding any other possible pathogenesis.CASE SUMMARY The patient presented with a 2-mo history of restricted mouth opening.Computed tomography showed obvious enlargement of the left pterygoid muscles.Furthermore,the patient had trismus without obvious predisposing causes.The primary diagnosis was pterygoid myosarcoma.Consequently,lesionectomy of the left pterygoid muscle was performed.Intraoperative frozen biopsy implied the possibility of an uncommon infection.Postoperative pathologic examination confirmed myositis and necrosis in the pterygoid muscle.Fungi were detected in both muscle tissue and surrounding necrotic tissue.The patient recovered well with antifungal therapy and mouth opening exercises.The rarity of fungal myositis may be responsible for the misdiagnosis.Although the origin of pathogenic fungi is still unknown,we believe that both hematogenous spread and local invasion could be the most likely sources.To the best of our knowledge,this is the
rst case in the literature that reported fungal myositis in pterygoid muscles as the only reason that results in trismus.CONCLUSION Surgeons should remain vigilant to the possibility of trismus originating from fungal myositis.

Endoscopic Adenoidectomy Secondary to Druginduced Trismus

We present the case of a 4 year old girl whose adenoidectomy had to be performed via an endoscopictrans oral approach due to the unexpected inability to fully open the mouth during the procedure. The patient had previously been taking Risperidone for behavioral symptoms associated with her autism. The jaw tone returned to normal following the procedure and there were no complications. An interaction between the Risperidone and the anesthetics were the likely cause of the trismus.

Efficacy of mouth opening exercises in treating trismus after maxillectomy

Background Patients with maxillary tumor often suffer from trismus after maxillectomy, which could turn out to be a permanent sequela without proper intervention. In this study, the efficacy of mouth opening exercises in preventing and treating trismus was observed in patients with maxillary tumor early after their operations. At the same time, radiotherapy as an influencing factor for the mouth opening exercises was evaluated. Methods In this study, 22 patients with maxillary oncology began their mouth opening exercises at an early stage （1-2 weeks） after maxillectomy. They were divided into two groups based on the principle of voluntariness： 11 patients in group 1 chose TheraBites as their instruments of mouth opening exercises, and the other 11 in group 2 chose stacked tongue depressors to help their exercises. All participants were trained to exercise 3-5 times a day, 30-40 oscillations at one time, with a 2-second pause at their maximum possible mouth open position. The maximal interincisor distances （MID） of patients were measured and recorded by a single investigator every week after the beginning of the mouth opening exercises. Medical information and the responses of patients were also recorded. Initial and final MIDs were calculated by SPSS 13.0. Results The changes of the mouth aperture every week during exercises in both groups were described in figures, and there were statistical increases in the final MIDs compared with the initial ones. However, no significant differences were achieved between groups 1 and 2 （P 〉0.05）. Radiotherapy seemed to have no negative impact on the mouth opening results during the exercises. Conclusion Physical mouth opening exercises should be executed early after maxillectomy for the prevention and treatment of trismus, especially for those who had radiotherapy as part of antitumor treatments.

Preliminary Outcome of Case Series of the Management of Unilateral and Bilateral Craniomandibular Ankylosis in Kenya <br/>—An Ongoing Prospective Study

Temporomandibularmandibular ankylosis also known as the craniomandibular joint (CMJ) ankylosis is a Greek terminology that means “stiff joint”. It is most commonly associated with trauma and to a lesser extent middle ear infections. The condition is debilitating with regard to nutrition, mantainance of oral hygiene, growth and the overall psychology state of the patient. In this paper we present preliminary results of an ongoing study to assess the clinical parameters, for example, maximum inter incisal opening (MIO) and chin deviation (CD) of patients with CMJ ankylosis receiving early surgical intervention.

Large Foreign Body in the Nasal Cavity, Maxillary Sinus and Infratemporal Fossa—Atypical Presentation

A 59-year-old male presented with complaints of trismus and discharge of altered blood from nose for 1 year. Patient had a history of facial trauma one year back. Nasal endoscopy and CT scan revealed a foreign body lodged in posterior half of both nasal cavity, left maxillary sinus and left infratemporal fossa penetrating the walls of maxillary sinus and nasal septum. Foreign body was removed by infratemporal fossa approach. This case has a rare location of a forgotten foreign body with atypical presentation.