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CT of the neck ruled out anatomical cause for trismus. Endoscopic evaluation showed bilateral vocal cord motion with patent subglottis and upper trachea without masses or purulence.
In the treatment of phlegmon of the mouth floor it is vital to secure the patency of the upper airways, especially in patients with intensified dyspnoea and trismus. It is believed that maintenance of airway patency is a priority procedure in treatment of infections of the deep spaces of the neck with impaired respiration [10].
There are two phases, the acute phase characterised by jaw pain, trismus and swelling of masticatory muscles and chronic phase, characterised by muscle atrophy (Anderson and Harvey, 1993; Melmed et al., 2004; Pitcher and Hahn, 2007).
Muhammad et al also recommended coronoidectomy in cases of trismus to achieve excellent mouth opening.
Under direct assault of the ionizing radiation, the TMJ and the muscles of mastication may ultimately undergo fibrosis and contracture resulting in trismus [89].
Over the next three weeks the patient presented on multiple occasions with worsening headache, impaired balance and trismus. Again the clinical findings remained unchanged despite further treatment with oral antiobiotics and further drops.
The most common symptoms are sore throat, dysphagia, fever and trismus. Almost all patients have a history of recurrent pharyngitis.
Speciic indings include trismus, stiff and small tongue, blanched and leathery floor of mouth, fibrotic and depigmented gingiva, rubbery soft palate with decreased mobility, blanched and atrophic tonsils, shrunken band like uvula and sinking of cheek not commensurate with age or nutritional status.