EpistemisTrismus
Specialty: Otolaryngology.
Why it occurs
- Acute peritonsillar abscess or phlegmon that compromises the pterygoid muscles due to contiguity
- Acute dysfunction or arthritis of the temporomandibular joint
- Odontogenic infection of the impacted lower third molar (pericoronaritis)
- Tetanus secondary to Clostridium tetani infection in unvaccinated patients
- Sequence of cervical or craniofacial radiotherapy due to progressive tissue fibrosis of the masseter and pterygoid muscles
- Malignant tumor of the masticatory space or infratemporal fossa
Initial workup
Careful exploration of the oral cavity (determining the interincisal distance in millimeters), CT of the neck with contrast to delineate purulent collections or masses, and maxillofacial MRI to evaluate in detail the temporomandibular joint and the pterygomandibular space.
red flags
High fever associated with intense sialorrhea and respiratory difficulty (stridor or dyspnea), deviation of the uvula with bulging of the anterior tonsillar pillar, generalized rigidity of the body muscles, unbearable unilateral ear pain, or a history of penetrating cervical trauma or dirty wound.
Standard management
- Broad-spectrum antibiotic therapy intravenously if there is tonsillar abscess, such as ampicillin-sulbactam — 1.5-3 g every 6 hours intravenously
- Systemic corticosteroids to reduce the muscular edema component, such as dexamethasone — 4-8 mg every 12 hours intravenously or intramuscularly
- Muscle relaxants such as diazepam — 5 mg orally every 12 hours
- Powerful pain relievers.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 6
- Treatment options
- 4