Objective: This study aims to investigate which, if any head and neck symptoms (trismus, dysphagia, alterations in speech or facial movements, and dyspnea) might be good predictors of outcomes (mortality, tracheostomy, discharged, decannulated) and prognosis of tetanus patients. Methods: Design: Retrospective Cohort Study Setting: Tertiary National University Hospital Patients: Seventy-three (73) pediatric and adult patients diagnosed with tetanus and admitted at the emergency room of the Philippine General Hospital between January 1, 2013 and December 31, 2017. Demographic characteristics, incubation periods, periods of onset, routes of entry, head and neck symptoms, stage, and outcomes were retrieved from medical records and analyzed. Results: Of the 73 patients included, 53 (73%) were adults, while the remaining 20 (27%) were pediatric. The three most common head and neck symptoms were trismus (48; 66%), neck pain/ rigidity (35; 48%), and dysphagia to solids (31; 42%). Results of multivariate logistic regression analysis showed that only trismus (OR = 3.742, p = .015) and neck pain/ rigidity (OR = 4.135, p = .015) were significant predictors of decannulation. No dependent variable/symptoms had a significant effect in predicting discharge and mortality. Conclusion: Clinically diagnosed tetanus can be easily recognized and immediately treated. Most of the early complaints are head and neck symptoms that can help in early diagnosis and treatment resulting in better prognosis. In particular, trismus and neck pain/rigidity may predict the outcome of decannulation after early tracheotomy, but not of discharge and mortality.
tracheotomy ; tetanus ; trismus ; Neck Pain ; Muscle Rigidity

PURPOSE: The aim of this study was to evaluate the effects of active mandibular exercise (AME) in patients with limited mouth opening after maxillomandibular fixation (MMF) release. METHODS: The study used a quasi-experimental, nonequivalent control group and a pre test-post test design. Sixty-two patients with Maxillomandibular Fixation Release were assigned to the experimental (n=31) or control group (n=31). The AME was performed in the experimental group for 4 weeks. The exercise AME consisted of maximal mouth opening, lateral excursion and protrusive movement. These movements were repeated ten times a day. After the final exercise of the day, the number of tongue blades used for mouth opening was noted. The effect of AME was evaluated after MMF release at different time intervals: a) immediately, b) after 1 week, c) after 2 weeks, d) after 4 weeks, and e) after 12 weeks. The exercise was assessed using the following criteria: a) mandibular movements, b) pain scores associated with maximal mouth opening, c) discomfort scores associated with range of movement, and d) daily life activities that involve opening the mouth. RESULTS: The experimental group showed significant improvement regarding the range of mandibular movements (maximal mouth opening (F=23.60, p < .001), lateral excursion to the right side (F=5.25, p=.002), lateral excursion to the left side (F=5.97, p=.001), protrusive movement (F=5.51, p=.001)), pain score (F=39.59, p < .001), discomfort score (F=9.38, p < .001). Daily life activities that involve opening the mouth were more favorable compared to those in the control group. CONCLUSION: The AME in patients after MMF release is helpful for increasing mandibular movement range, decreasing pain and discomfort, and improving day life activities that involve opening the mouth. Therefore, AME is highly recommended as an effective nursing intervention.
Exercise Movement Techniques ; Humans ; Jaw Fixation Techniques ; Mouth Rehabilitation ; Mouth ; Muscle Stretching Exercises ; Nursing ; Quality of Life ; Tongue ; Trismus

BACKGROUND: Third molar extraction is associated with considerable pain and discomfort, which is mostly managed with oral analgesic medication. We assessed the analgesic effect of benzydamine hydrochloride, a topical analgesic oral rinse, for controlling postoperative pain following third molar extraction. METHODS: A randomized controlled trial was conducted in 40 patients divided into two groups, for extraction of fully erupted third molar. Groups A received benzydamine hydrochloride mouthwash and group B received normal saline gargle with oral ibuprofen and paracetamol. Oral ibuprofen and paracetamol was the rescue analgesic drug in group A. Patients were evaluated on the 3(rd) and 7(th) post-operative days (POD) for pain using the visual analogue score (VAS), trismus, total number of analgesics consumed, and satisfaction level of patients. RESULTS: The VAS in groups A and B on POD3 and POD7 was 4.55 ± 2.54 and 3.95 ± 1.8, and 1.2 ± 1.64 and 0.95 ± 1.14, respectively and was statistically insignificant. The number of analgesics consumed in groups A and B on POD3 (5.25 ± 2.22 and 6.05 ± 2.43) was not statistically different from that consumed on POD7 (9.15 ± 5.93 and 10.65 ± 6.46). The p values for trismus on POD3 and POD7 were 0.609 and 0.490, respectively and those for patient satisfaction level on POD3 and POD7 were 0.283 and 0.217, respectively. CONCLUSIONS: Benzydamine hydrochloride oral rinses do not significantly reduce intake of oral analgesics and are inadequate for pain relief following mandibular third molar extraction.
Acetaminophen ; Analgesics ; Benzydamine ; Humans ; Ibuprofen ; Molar, Third ; Pain, Postoperative ; Patient Satisfaction ; Pilot Projects ; Tooth Extraction ; Trismus

BACKGROUND: This study aimed to evaluate the anti-inflammatory efficacy of preemptive intravenous ibuprofen on inflammatory complications such as edema and trismus in patients undergoing impacted mandibular third molar surgery. METHODS: Sixty patients were included and divided into three groups (800 mg IV ibuprofen + 50 mg dexketoprofen, 800 mg IV ibuprofen, and control). In all patients, preoperative hemodynamic values were recorded before the infusions. The operation was started at 15-min post-infusion. Evaluation of edema size on the face and mouth opening (trismus) was conducted in the preoperative period, and at postoperative 48 h and 1 week. RESULTS: No difference was determined among the groups in trismus and edema size in postoperative measurements (P > 0.05). There was a difference between group 2 and group 3 only in measurement value of tragus-corner of the mouth on the postoperative day 2 (P < 0.05). A difference was found between the measurement values of trismus preoperatively and at preoperative day 2, and between postoperative day 2 and 1 week in group 3 based on time (P < 0.05). In group 3, edema on the face on postoperative day 2 increased significantly compared to that in the preoperative period (P < 0.001); in addition, edema increased significantly in groups 1 and 2 in the postoperative period but was less than that in group 3 (P < 0.001). CONCLUSIONS: In this study, intravenous ibuprofen was determined to be more effective alone or in combination in alleviating trismus and to better limit the postoperative edema.
Edema ; Hemodynamics ; Humans ; Ibuprofen ; Molar, Third ; Mouth ; Postoperative Period ; Preoperative Period ; Tooth Extraction ; Tooth ; Trismus

The development of office-based, unsedated transnasal esophagoscopy (TNE) has proven to be a major technological advance and with time and experience the application of this technology is becoming more widespread. TNE has allowed otolaryngologists to perform a variety of diagnostic and therapeutic procedures in the office setting. Studies consistently demonstrate that the image quality and diagnostic capability of TNE is equivalent to conventional esophagoscopy. The modern TNE endoscopes offer high quality optics, air-insufflation, and irrigation capability through a 2-mm working channel, and the ability to perform biopsies and select procedures. In general, the role of TNE in the head and neck patient is three-fold : to screen for synchronous and metachronous esophageal squamous cell carcinoma (ESCC) ; to differentiate post-treatment changes/symptoms from malignancy ; and to perform certain office-based procedures. TNE offers many specific advantages to the head and neck patient that are not afforded by conventional esophagoscopy. Because of surgical and postirradiation changes, many HNSCC patients have trismus or neck stiffness preventing completion of conventional transoral esophagoscopy. Perhaps most importantly, TNE provides enhanced patient safety, increased tolerability, better practice efficiency, and cost savings. For these reasons, TNE has become a particularly useful tool in the otolaryngologist's armamentarium.
Biopsy ; Carcinoma, Squamous Cell ; Cost Savings ; Endoscopes ; Esophagoscopy ; Head ; Head and Neck Neoplasms ; Humans ; Neck ; Patient Safety ; Trismus

A 70-year-old male with a history of diabetes mellitus, hypertension, and coronary stent insertion visited our hospital 7 days after biting his lower lip. Swelling and inflammation had worsened despite debridement and antibiotic treatment. On the 8th hospital day, fungal infection with Candida albicans and superimposed bacterial infection with Klebsiella pneumoniae were found on tissue culture. Extensive necrosis resulted in a defect of approximately 3/4 of the entire lower lip and a full-layer skin defect from the vermilion to the gingivobuccal sulcus at the right corner of the mouth. To correct drooling, incomplete lip sealing, and trismus, staged reconstruction was performed with consideration of cosmetic and functional features. The treatment process using staged reconstruction and antifungal treatment for an extensive lower lip defect caused by fungal stomatitis is described.
Aged ; Bacterial Infections ; Candida ; Candida albicans ; Debridement ; Diabetes Mellitus ; Gangrene ; Humans ; Hypertension ; Inflammation ; Klebsiella pneumoniae ; Lip* ; Male ; Mouth ; Necrosis ; Noma* ; Sialorrhea ; Skin ; Stents ; Stomatitis ; Trismus

BACKGROUND AND OBJECTIVES: The incidence of facial bone fracture is increasing. The zygomatic bone, due to its anatomical prominence, is the second most common site of all facial bone fractures. In this study, we present the clinical experiences of zygomatic arch fracture in a tertiary hospital and introduce the Gillies approach for reduction and its outcome results. SUBJECTS AND METHOD: We collected data from retrospective chart reviews of patients who underwent surgeries from 2010 to 2017 for zygomatic arch fractures at Chungbuk National University Hospital. Data were analyzed according to age, gender, cause of trauma, location of trauma, and clinical symptoms including trismus. All surgery was performed under general anesthesia and via the use of Gillies approach. The result of surgery was evaluated by postoperative facial computed tomography. RESULTS: Sixteen patients underwent surgery for zygomatic arch fracture. The patients had the average age of 41.3 years, a male predominance of 15:1 and physical assault as the most common cause of trauma. The time lag between injury and surgical reduction was 5.5 days. The surgical outcomes were assessed “good” in 14 cases and “moderate” in one case. Patients who had trismus preoperatively were resolved of it in all cases after operation. Postoperative complications were absent. CONCLUSION: The Gillies approach proved to be a relatively easy, safe, and reliable method, and its surgical outcomes was satisfactory in our experiences.
Anesthesia, General ; Chungcheongbuk-do ; Facial Bones ; Humans ; Incidence ; Male ; Methods ; Postoperative Complications ; Retrospective Studies ; Tertiary Care Centers ; Trismus ; Zygoma*

OBJECTIVE: To compare the effects of low intensity ultrasound (LIUS), traditional exercise therapy (TET), low level laser therapy (LLLT) and TET on temporomandibular joint (TMJ) pain and trismus following recovery from head and neck cancer (HNC). METHODS: Sixty participants following, who had experienced HNC, were randomly allocated to three groups of 20 people each. Each group received different therapy. Group A received LIUS and TET; group B received LLLT and TET; while group C received TET. All 60 participants were evaluated under the visual analog scale (VAS), the University of Washington Quality of Life questionnaire (UW-QOL) and the Vernier caliper scale (VCS) at the beginning of the therapies and after 4 weeks. RESULTS: ANOVA test revealed significant improvements across all three groups with outcomes of p < 0.05. The results of the UW-QOL questionnaire showed a significant difference between groups A, B and C in favor of group A (p < 0.05). The VAS results showed a more improvement in group A as compared to group B (p < 0.05), while there was no statistical difference between groups B and C (p>0.05). The VCS results showed more improvement for the individuals in group B as compared to those in group C (p < 0.05), while there was minimal difference between groups A and B (p>0.05). CONCLUSION: The LIUS and TET are more effective than LLLT and/or TET in reducing TMJ pain and trismus following HNC.
Exercise Therapy ; Exercise* ; Head and Neck Neoplasms* ; Head* ; Low-Level Light Therapy ; Quality of Life ; Temporomandibular Joint* ; Trismus* ; Ultrasonics ; Ultrasonography* ; Visual Analog Scale ; Washington

Zygomatic mastoiditis is an extremely rare cause of an inflamed, swollen cheek. We encountered a 10-year-old girl with left preauricular swelling, pain, and mild trismus. Temporal bone computed tomography revealed a zygomatic root abscess with bone defects and a scanty amount of soft tissue lesion in Prussak's space. After antibiotic therapy for 2 weeks, her pain subsided, but the swelling persisted. All inflamed air cells, including the lesion in the zygomatic root, were eradicated. The swelling subsided after the surgery. The patient has not experienced any postoperative complications or shown any evidence of relapse for more than 1 year.
Abscess ; Cheek ; Child ; Female ; Humans ; Mastoid ; Mastoiditis ; Postoperative Complications ; Recurrence ; Temporal Bone ; Trismus ; Zygoma

Objective:: To describe a unique case of extrapulmonary tuberculosis (TB) of the temporomandibular area focusing on its insidious and destructive course over a 2-year period with insights into the diagnostic and therapeutic pitfalls encountered throughout its clinical development. Methods:: Study Design: Case Report. Setting: Tertiary Government Hospital. Patient: One. Results: A 33-year old man initially presented with right pre-auricular swelling and trismus that were unresponsive to antibiotic therapy. On subsequent follow-ups, initial symptoms were accompanied by a non-healing right pre-auricular wound, right ear discharge, trismus, and right facial paralysis (House-Brackmann III). Cranial and temporal bone computed tomography scans revealed osteolytic destruction of the right temporomandibular region extending to the auditory canal and of the right mastoid bone extending to the right mandibular condyle and parotid. Infected malignancy of the parotid, mandible and temporal bone were considered, but definitive diagnosis from an incision biopsy revealed caseating granulomatous inflammation consistent with tuberculosis. He was started on anti-tuberculosis medications with significant resolution of pre-auricular swelling, non-healing pre-auricular wound, facial paralysis and ear discharge but minimal improvement in mouth opening. Conclusion Tuberculosis of temporomandibular region is rare and is associated with nonspecific manifestations. Delay in diagnosing and initiating appropriate treatment can lead to morbidity and serious complications involving destruction of the temporal bone, middle ear, mandible and parotid gland over its progression. A high index of suspicion by the physician and awareness of the patient’s health seeking behaviors could have aided in the early diagnosis and treatment of this extrapulmonary TB.
Human ; Male ; Tuberculosis ; Trismus ; Facial Paralysis ; Temporomandibular Joint Disorders