Lara F. de Almeida, DO
PGY-2 PM&R Resident
The Ohio State University
Columbus, Ohio, United States
Kevin J. Brown, BA
Fourth-Year Medical Student
University of Toledo College of Medicine and Life Sciences
Toledo, Ohio, United States
Gretchen Harknett, DO
Resident Physician
The Ohio State University
Columbus, Ohio, United States
.jpg "Timothy S. Hake, MD photo")
Timothy S. Hake, MD
Dodd Rehabilitation Hospital Medical Director
The Ohio State University Physical Medicine and Rehabilitation
Columbus OH, Ohio, United States
A 50-year-old male with no significant past medical history was admitted to an inpatient rehabilitation hospital after a complicated acute hospital stay following a large right PICA territory ischemic stroke with hemorrhagic conversion, hydrocephalus, and mass effect resulting in tonsillar herniation. He underwent decompressive craniectomy and ventriculoperitoneal shunt placement during his acute hospitalization. He was noted to have spastic trismus during his inpatient rehabilitation hospitalization which was affecting his oral hygiene and evaluation of his dysphagia. Electromyography needle showed bilateral hypertonicity of the masseter and temporalis muscles which was more significant on the left, and his interincisal distance was 1 cm. A three day course of tizanidine only resulted in minor improvement and was discontinued. A total of 100 units of botulinum toxin was injected into the bilateral masseter and temporalis muscles on day 7 of his inpatient rehabilitation hospitalization with improved outcomes.
Discussions:
Post-stroke spastic trismus is a rare but significant complication, characterized by spastic hypertonia in the masseter and temporalis muscles, leading to restricted jaw opening. Although specific research on post-stroke spastic trismus is limited, spasticity affects 25% to 43% of stroke survivors within the first year. This condition can severely impact oral hygiene, speech, mastication, and swallowing, potentially causing permanent impairment if not addressed promptly. Effective management involves targeted rehabilitation exercises for the temporomandibular joint, botulinum toxin injections guided by electromyography, and medications such as baclofen and tizanidine. Early diagnosis and a multidisciplinary approach are essential for optimal treatment and improved patient outcomes.
Conclusions:
Spastic trismus is a rare complication of ischemic stroke that can impair a person’s ability to eat, speak, and perform oral hygiene. Health professionals involved in stroke rehabilitation should be aware of this potential complication to ensure prompt diagnosis and treatment.
