Management of restricted mouth opening due to Temporomandibular joint disorders

Abstract

Background

Restricted mouth opening, which is also known as Limited mouth opening, trismus, or lockjaw, has several causes and Temporomandibular joint disorders are considered as the main cause.

Purpose

This study aimed to retrospectively review the causes of restricted mouth opening due to TMJ and its management.

Study design

A retrospective cohort study of subjects who underwent Management of locked jaw Due to TMJ. A total of 879 consecutive patients with locked jaw in the period from 2016 to 2022 were reviewed for the causative factor and its management.

Main outcome variable(s)

maximum inter-incisal opening (MIO in mm), pain in the TMJ (Yes/No) using the visual analogue score (VAS).

Results

the final sample consisted of 409 patients. Irreducible disc displacement represented 60 % of the total cases (245 patients with mean age 31.7 ± 5.5). Followed by TMJ osteoarthritis which represented 12 % (48 patients with mean age 38.4 ± 8.3), Joint adhesion Secondary to Immobilization (9 %), post-surgical represented 8.5 %, Anchored disc phenomenon (7.5 %). While ankylosis, coronoid hyperplasia, radiotherapy, were represented only 3 % (14 patients). Arthrocentesis with joint injection successfully used in treatment of 394 (96 %). Out of them, 21 patients didn’t respond to the arthrocentesis and treated by second intervention with TMJ arthroscopy level II. 6 patients with TMJ ankylosis treated with Hegab protocol while one patient with failed joint prosthesis was treated with Total joint replacement.

Conclusions

Arthrocentesis with joint injection could be used effectively in most cases of locked jaw secondary to TMJ. While TMJ arthroscopy could be used in un-responded cases.

1

Introduction

Restricted mouth opening or lockjaw is not a disease by itself rather than a manifestation of underlying causes which ranges from simple cause to potentially life-threatening causes [ , ]. Temporomandibular joint (TMJ) disorders represent one of the major causes of restricted mouth opening and the diagnostic imaging play an important role in the evaluation of the causative factor. While MRI is also reliable for the detection of internal derangement, especially for anterior disc displacement with or without reduction, the diagnostic accuracy for evaluating the presence of intra-articular adhesions is rather poor [ , ] .

Tabel 1
showed the demographic data of the patients and the Statistical analyses of the relationships of age and gender with the outcomes of the study in the patients with restricted mouth opening.
Causative factor No of patients Percentage Gender Mean Age Study Variable P Value
128M (31 %) 281 F (69 %) Gender Age
Irreducible anterior disc displacement 245 60 % 67 178 31.7 + 5.5 Mouth opening (mm) 0.9088 ns 0.4722 ns
Pain (0–10 VAS) <0.0001 0.0278∗
Osteoarthritis 48 12 % 13 35 38.4 ± 8.3 Mouth opening (mm) 0.0200 0.8268 ns
Pain (0–10 VAS) 0.0035 0.6020 ns
Joint adhesion Secondary to Immobilization 36 9 % 26 10 31.9 ± 5.5 Mouth opening (mm) 0.4259 ns 0.8977 ns
Pain (0–10 VAS) 0.2287 ns 0.7878 ns
Post-surgical 35 8.5 % 7 28 32.5 ± 5.6 Mouth opening (mm) 0.0218 0.0336
Pain (0–10 VAS) 0.3296 ns 0.1568 ns
Anchored disc phenomenon/joint adhesion 31 7.5 % 9 22 32.3 ± 4.8 Mouth opening (mm) 0.0045 0.2710 ns
Pain (0–10 VAS) 0.1988 ns 0.9164 ns
Ankylosis 7 3 % 2 5 25.4 ± 5.6 Mouth opening (mm) 0.1337 ns 0.8571 ns
Pain (0–10 VAS) 0.0347 0.2845 ns
limitation of mouth opening after radiotherapy 4 4 – 55.7 ± 7.4 Mouth opening (mm) NA – all Male 0.8824 ns
Pain (0–10 VAS) NA – all Male 0.0864 ns
Coronoid Hyperplasia 3 – 3 39.0 ± 2.6 Mouth opening (mm) NA – all Female 0.8516 ns
Pain (0–10 VAS) NA – all Female 0.2636 ns

Table 2
Causative factor Management Variable Preoperative at 1M at 3 M at 6 M at 12 M P-Value
DDNR Arthrocentesis/Arthroscopic
Lysis and lavage + joint injection With HA or HA/PRP mix		 MVMO Mean + SD 22.4 ± 2.35 34.13 + 2.2 37.44 + 1.45 39.13 + 1.1 39.43 ± 1.1 <0.0001
Lower 95 % CI of mean 22.14 33.85 37.26 38.98 39.29
Upper 95 % CI of mean 22.73 34.41 37.63 39.27 39.56
VAS Mean + SD 7.5 ± 0.87 3.05 ± 0.86 0.43 ± 0.57 0.0 ± 0.0 0.0 ± 0.0 <0.0001
Lower 95 % CI of mean 7.429 2.936 0.3605 0.0 0.0
Upper 95 % CI of mean 7.649 3.154 0.5048 0.0 0.0
Osteoarthritis Arthrocentesis Lysis and lavage + joint injection With HA or HA/PRP mix MVMO Mean + SD 24.25 ± 2.1 35.04 ± 3.17 38.35 ± 2.9 39.65 ± 2.5 41.69 ± 2.3 <0.0001
Lower 95 % CI of mean 23.64 34.12 37.51 38.92 41.01
Upper 95 % CI of mean 24.86 35.96 39.20 40.38 42.37
VAS Mean + SD 7.87 ± 1.0 5.13 ± 2.749 2.63 ± 2.11 1.00 ± 0.99 0.25 ± 0.6 <0.0001
Lower 95 % CI of mean 7.572 4.327 2.012 0.7127 0.07537
Upper 95 % CI of mean 8.178 5.923 3.238 1.287 0.4246
Post-surgical Arthrocentesis
Lysis and lavage with HA/PRP mix (34 patients)
– open joint surgery (1 patients)		 MVMO Mean + SD 25.60 ± 3.3 36.03 ± 2.2 38.86 ± 1.7 40.63 ± 2.0 38.86 ± 2.6 <0.0001
Lower 95 % CI of mean 24.46 35.27 38.29 39.93 37.96
Upper 95 % CI of mean 26.74 36.79 39.43 41.33 39.76
VAS Mean + SD 7.06 ± 1.3 2.89 ± 0.83 0.31 ± 0.47 0.34 ± 0.54 1.6 ± 1.3 <0.0001
Lower 95 % CI of mean 6.609 2.600 0.1525 0.1576 1.150
Upper 95 % CI of mean 7.505 3.172 0.4761 0.5281 2.050
Anchored disc phenomenon Arthrocentesis
Lysis and lavage + joint injection with HA		 MVMO Mean + SD 22.74 ± 2.35 32.35 ± 1.82 36.65 ± 1.52 38.74 ± 0.99 38.74 ± 0.99 <0.0001
Lower 95 % CI of mean 21.88 31.69 36.09 38.38 38.38
Upper 95 % CI of mean 23.60 33.02 37.20 39.11 39.11
VAS Mean + SD 6.9 ± 0.72 2.484 ± 057 0.13 ± 034 0.0 ± 0.0 0.0 ± 0.0 <0.0001
Lower 95 % CI of mean 6.607 2.275 0.004035 0.0 0.0
Upper 95 % CI of mean 7.134 2.693 0.2540 0.0 0.0
Joint adhesion Secondary to Immobilization Arthrocentesis/Arthroscopic
Lysis and lavage + joint injection with HA		 MVMO Mean + SD 21.69 + 2.08 32.97 + 2.65 36.61 + 1.48 39.06 + 1.41 39.11 + 1.41 <0.0001
Lower 95 % CI of mean 20.99 32.08 36.11 38.58 38.63
Upper 95 % CI of mean 22.40 33.87 37.11 39.53 39.59
VAS Mean + SD 6.89 + 0.62 2.36 + 0.79 0.056 + 0.23 0.0 + 0.0 0.0 + 0.0 <0.0001
Lower 95 % CI of mean 6.678 2.091 −0.023 0.0 0.0
Upper 95 % CI of mean 7.099 2.631 0.134 0.0 0.0
Ankylosis Hegab Protocol [ ]/Total Joint Replacement MVMO Mean + SD 1.86 + 0.896 33.57 + 5.83 36.43 + 5.2 38.29 + 4.7 38.57 + 4.96 <0.0001
Lower 95 % CI of mean 1.025 28.18 31.63 33.92 33.98
Upper 95 % CI of mean 2.689 38.96 41.23 42.65 43.16
VAS Mean + SD 2.3 + 2.6 3.86 + 1.95 2.57 + 1.7 0.86 + 1.5 0.7 + 1.5 0.0075
Lower 95 % CI of mean −0.1445 2.052 0.9823 −0.4967 −0.6693
Upper 95 % CI of mean 4.716 5.662 4.161 2.211 2.098
limitation of mouth opening after radiotherapy Release Surgery + Physiotherapy MVMO Mean + SD 21.25 + 4.35 26.25 + 2.87 29.50 + 1.29 33.00 + 0.82 34.75 + 1.25 0.0694ns
Lower 95 % CI of mean 14.33 21.68 27.45 31.70 32.75
Upper 95 % CI of mean 28.17 30.82 31.55 34.30 36.75
VAS Mean + SD 8.00 + 0.82 6.00 + 0.82 4.75 + 1.26 4.00 + 0.82 4.00 + 0.82 <0.0001
Lower 95 % CI of mean 6.701 4.701 2.748 2.701 2.701
Upper 95 % CI of mean 9.299 7.299 6.752 5.299 5.299
Coronoid Hyperplasia Coronidectomy + Physiotherapy MVMO Mean + SD 20.67 + 2.56 37.33 + 2.08 40.00 + 2.00 41.67 + 2.89 42.67 + 2.52 <0.0001
Lower 95 % CI of mean 14.42 32.16 35.03 34.50 36.42
Upper 95 % CI of mean 26.92 42.50 44.97 48.84 48.92
VAS Mean + SD 2.67 + 1.53 1.67 + 0.58 0.0 + 0.0 0.0 + 0.0 0.0 + 0.0 <0.0001
Lower 95 % CI of mean −1.128 0.2325 0.0 0.0 0.0
Upper 95 % CI of mean 6.461 3.101 0.0 0.0 0.0
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Jun 23, 2025 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Management of restricted mouth opening due to Temporomandibular joint disorders

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