PATIENT & CAREGIVER EDUCATION
Preventing Trismus
This information will help you prevent trismus during and after your surgery orradiation therapy.
The Structure of Your Jaw
Your jaw is made up of a pair of bones that form the framework of your mouthand teeth (see Figure 1). Your upper jaw is called the maxilla and your lower jawis called the mandible. Your mandible connects to your skull at thetemporomandibular joint (TMJ).
Figure 1. The bones and muscles of the jaw
Many muscles and nerves around the jaw work together to open and close yourmouth. Most people are able to open their mouth 35 to 55 millimeters, which isabout the width of 3 fingers (see Figure 2).
Preventing Trismus1 of 10
Figure 2. Normal width of anopen mouth
Trismus
Trismus is a condition in which someone has difficulty opening their mouth.Trismus can occur anytime during, right after, or even years after yourtreatment. It can develop:
If you have a tumor that involves the bones, muscles, and nerves that openthe mouth.
After surgery to the head and neck.
After radiation therapy to the head and neck.
You may develop fibrosis (scarring) as the tissues begin to heal from surgery.Fibrosis can also build up years after radiation therapy.
When you can’t open your mouth well, it is hard for your doctor to examine thisarea. You may also have problems:
Cleaning your mouth and teeth. This may lead to bad breath, cavities, andinfections.
Chewing and swallowing. This can make it difficult for you to eat and drink.TalkingKissing
Having a breathing tube placed, if you ever need general anesthesia(medication to make you sleep during a surgery or procedure).Having routine dental treatment.
Preventing Trismus
2 of 10
Once trismus develops, it is very hard to treat. That is why it is important toprevent trismus and to treat it as early as possible.
How to Prevent Trismus
There are 4 ways to help prevent trismus. Even if you don’t have any symptoms,you should do the following to prevent problems:
Massage your jaw muscles.Exercise your jaw muscles.Maintain good posture.Maintain good oral hygiene.
There are a number of exercises described below. During the exercises, breathenormally and do not hold your breath. If any of these exercises cause pain,
numbness, or tingling, stop them right away and call your doctor or nurse. If youhave had surgery, check with your doctor or nurse before you begin theseexercises.
Massage Your Jaw Muscles (Masseter Muscle)
Place your index and middle finger on your cheekbone. Run your fingers down over your massetermuscle, which ends at your bottom jaw (see Figure3). As you move your fingers, find points that feeltender or tight. Massage these areas with yourfingers in a circular direction for 30 seconds. Do this2 to 3 times a day.
To keep your jaw muscles relaxed all the time, avoidclenching your jaw when you are stressed or out ofhabit.
Figure 3. Massaging thejaw muscles
Exercise Your Jaw Muscles
Use a mirror for these exercises to help you do them
correctly. These movements should give you a good stretch, but not cause pain.Do these exercises 2 to 3 times a day.
Preventing Trismus3 of 10
Active range of motion and stretching exercises
Sit or stand. Hold your head still while doing these exercises.
1. Open your mouth as wide as you can, until you can feel a good stretch butno pain (see Figure 4). Hold this stretch for ____ seconds.
Figure 4. Mouth open wide
2. Move your jaw to the left (see Figure 5). Hold this stretch for 3 seconds.
Figure 5. Jaw moved to the left
3. Move your jaw to the right (see Figure 6). Hold this stretch for 3 seconds.
Figure 6. Jaw moved to the right
Preventing Trismus
4 of 10
4. Move your lower jaw in a circle. Make 5 circles in each direction.
Passive stretching exercise
1. Place 1 thumb on your top teeth in the middle of your jaw.
2. Place the pointer (index) finger of your other hand on your bottom teeth, inthe middle of your jaw.3. Open your mouth with your fingers, but do not bite down or resist (seeFigure 7). Let your fingers do all of the work. Hold this stretch for ___seconds.
Figure 7. Mouth opened withindex finer and thumb
Maintain Good Posture
Good posture means sitting and standing with your ears, shoulders, hips, knees,and ankles aligned. To maintain good posture, you need to keep your neck andshoulders strong and flexible (see Figure 8). The exercises listed below will helpyou do this. Do these exercises twice a day.
Preventing Trismus5 of 10
Figure 8. Maintaining goodposture
Neck stretch
Sit or stand with your arms at your side. Hold each stretch for 30 seconds.1. Bend your head forward (see Figure 9).
Figure 9. Head bent forward
2. Bend your head backwards (see Figure 10).
6 of 10
Preventing TrismusFigure 10. Head bentbackwards
3. Rotate your head to the right (see Figure 11).
Figure 11. Head
rotated to the right
4. Rotate your head to the left (see Figure 12).
Figure 12. Headrotated to the left
5. Bring your left ear to your left shoulder (see Figure 13).
7 of 10
Preventing TrismusFigure 13. Headbent to the left
6. Bring your right ear to your right shoulder (see Figure 14).
Figure 14. Headbent to the right
8 of 10
Preventing TrismusChin tuck
1. Sit or stand with your arms atyour side.
2. While looking forward, tuck yourchin.3. Pull your head back to line upyour ears with your shoulders(see Figure 15). Hold this positionfor 3 seconds.
4. Do this exercise 10 times slowly.
Figure 15. Chin tucked and head pulledback
Shoulder blade pinch
1. Sit or stand with your arms at your side. Tuck your chin, as described in thechin tuck exercise above.
2. Pinch your shoulder blades together as tightly as possible (see Figure 16).3. Hold this position for 3 seconds.4. Do this exercise 10 times slowly.
Figure 16. Shoulder bladespinched together
Maintain Good Oral Hygiene
Preventing Trismus
9 of 10
Brush your teeth and tongue when you wake up, after each meal, and atbedtime.
If you have removable dentures or a dental prosthesis, take it out and cleanit each time you clean your mouth. Do not sleep with these devices in yourmouth.
Floss your teeth once daily at bedtime.
If You Develop Tightness When OpeningYour Mouth
The earlier you start treatment for trismus, the easier it will be to restore yourjaw function. If you notice any tightening in your jaw, call your doctor or nurseright away. They can refer you to:
Speech and swallowing specialists and physical therapists. They can helpyou maintain and restore your ability to open your mouth. They use manytechniques, such as exercise, stretching, and massage. They may alsorecommend special devices to help you open your mouth.
Rehabilitation doctors. They will evaluate how well you can open yourmouth. They may give you medication for pain or spasms (sudden intensecramping in your muscle) or suggest other treatments to help you.
If you have any questions or concerns, talk with a member of your
healthcare team. You can reach them Monday through Friday from 9:00 AMto 5:00 PM at ____________________. After 5:00 PM, during theweekend, and on holidays, please call____________________. Ifthere’s no number listed, or you’re not sure, call 212-639-2000.
©2016 Memorial Sloan Kettering Cancer Center - Generated on March 22, 2016
Preventing Trismus10 of 10
