BACKGROUND: Isaacs\' syndrome, also known as neuromyotonia or peripheral nerve hyperexcitability, is a rare disorder that affects the peripheral nervous system. Clinical findings include cramps, fasciculations, and myokymia; however, there are few reports of dental treatment for trismus.
METHODS: A patient with trismus due to Isaacs\' syndrome experienced swelling and pain in the gingiva surrounding his right lower first molar. He was diagnosed with chronic apical periodontitis by a dentist near his home. However, the patient was informed that dental treatment and medication could not be administered because of the presence of Isaacs\' syndrome, and he visited the Geriatric Dentistry and Perioperative Oral Care Center at Kyushu University Hospital 2 weeks later. The patient\'s painless mouth-opening distance (between incisors) was 20 mm at that time, and medication, including amoxicillin capsules and acetaminophen, was administered because the dental extraction forceps or endodontic instruments were difficult to insert into the oral cavity for treatment. Two months after his initial visit, the patient visited us complaining of pain in the same area. However, he had recently undergone plasmapheresis treatment in neurology to alleviate limited mouth opening and systemic myalgia, resulting in a pain-free mouth-opening distance of approximately 35 mm. During this temporary period in which he had no restriction in mouth opening, we performed tooth extraction and bridge restoration on the mandibular right first molar and created an oral appliance for sleep bruxism.
CONCLUSIONS: Plasmapheresis therapy transiently reduced trismus, rendering dental interventions feasible, albeit temporarily. This case report underscores the importance of close collaboration between neurologists and dentists who encounter similar cases while furnishing valuable insights to inform dental treatment planning.

A patient presenting with a history of restricted mouth opening and deflection of the mandible after a prolonged dental procedure raises a suspicion of temporomandibular joint disorder (TMD) due to its estimated high prevalence of 29%. Muscle relaxants and routine active physiotherapy established normal range of movement and pain reduction was achieved through TENS therapy and analgesics. However, the non-subsidence of deflection prompted an initial suspicion of TMD which was overturned by MRI. The MRI evaluation revealed left side medial pterygoid abscess. It is imperative to understand that despite strong history and relevant clinical features, for the definitive diagnosis radiographic evaluation is highly contributory. Misdiagnosing TMD due to its similar presentation can have significant implications for the patient\'s well-being and quality of life. The clinical features of medial pterygoid abscess including restricted mouth opening and pain can be similar to that of TMD. These abscesses are most commonly caused by odontogenic infections but can also occur as a result of septic inferior alveolar nerve block techniques. Limited literature reports of pterygoid space abscess have been described, but intramuscular and medial pterygoid abscess is an absolute rarity. Causal relationship to septic inferior alveolar nerve block further makes this case report an interesting read.

UNASSIGNED: Soft tissue injuries are known complications of orthodontic treatment. Most of the injuries are mild, but severe complications can arise from deeper penetration or dislodgement of brackets and other foreign bodies into the surrounding tissues of the oropharynx and infratemporal fossa.
UNASSIGNED: The patient, accompanied by his parents, presented to the Children\'s Emergency Department with the concern of gradual limitation of mouth opening and eventual trismus, which occurred over a span of 2 weeks.
UNASSIGNED: The patient presented with trismus and slight discomfort at the left cheek region. He reported a history of gradual limitation to his mouth opening 2 weeks prior. He was wearing upper and lower fixed orthodontic appliances and the left distal end of the maxillary archwire was found to have migrated into the left infratemporal fossa.
UNASSIGNED: Left medial pterygoid muscle inflammation, or bleeding and haematoma formation, or infection within the infratemporal region.
UNASSIGNED: The maxillary archwire was removed in the Children\'s Emergency Department and a computed tomography (CT) scan performed subsequently confirmed the diagnosis of left medial pterygoid muscle inflammation. The patient was started on an intravenous (IV) antibiotic and a 2-day course of IV dexamethasone to reduce the muscle inflammation.
UNASSIGNED: By the second day, the patient was able to achieve a mouth opening of 6 mm, and by the second week, the mouth opening had returned to normal.
UNASSIGNED: The potential risk of soft tissue injury and complications from orthodontic treatment is generally mild and limited. Soft tissue injuries can be avoided with careful management by the operator with the proper precautions taken. Clinicians should be familiar with the surrounding soft tissue anatomy and be aware of the potential for more severe complications and provide management or referral to the appropriate specialty accordingly.

Trismus is a common, extremely detrimental side effect following definitive radiotherapy for head and neck malignancies. Existing therapeutic modalities (active and passive range-of-motion exercises and systemic therapies) offer only modest, slow improvements in jaw opening; thus, there is a need for additional treatment options. Boswellia serrata (BS) (\"Indian frankincense\") is a tree native to West Asia and North Africa that produces resin-containing \"boswellic\" acids. These have been shown to have in vitro and in vivo anti-inflammatory effects and have previously been found to be an effective treatment for asthma, colitis, arthritis, and post-radiation edema. Herein we report the case of a 54-year-old male with severe post-radiation trismus who experienced a dramatic resolution with BS/Therabite® combination therapy. His trismus improved from 6 mm to 45 mm over 10 weeks (0.46 mm/day), far exceeding previous rates of improvement documented in the literature. There were no ill effects. Given the dearth of effective treatments for post-radiation trismus, BS is a promising agent deserving of further study.

Tetanus is a life-threatening infectious neurological condition that has become uncommon due to large-scale immunization campaigns. We describe a rare instance of generalized tetanus presenting with a headache on a tropical island in Malaysia. A 43-year-old woman presenting with headaches and generalized body weakness, which progressed into trismus and neck stiffness. Her medical history indicated a wound on the sole of her foot caused by shattered glass in an unhygienic area, but no tetanus prophylaxis had been administered. The patient was subsequently given immunoglobulin, tetanus toxoid, metronidazole, and sedatives in the recommended dosages. Her neurological condition improved remarkably, but she suffered blood pressure fluctuations due to dysautonomia. She was successfully discharged with complete recovery after 6 months of follow-up. The case demonstrates the significance of appropriate identification and care of tetanus, as well as the lethal effects of untreated wounds in vulnerable patients.

BACKGROUND: Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a rare neurological condition with paraneoplastic etiology in about 20% of cases, usually presenting before or shortly after the oncological diagnosis is established. PERM associated with anti-glycine receptor antibodies is not previously reported in a patient with bladder cancer.
METHODS: A 72-years-old Caucasian male was admitted with acute onset of dysarthria, dysphagia and trismus three years after initial surgical treatment for bladder cancer. The condition was initially diagnosed as tetanus and treated accordingly, but the diagnosis was reconsidered because of progression despite adequate treatment. Diagnostic workup on readmission revealed lung and paraaortal metastases from bladder cancer and anti-glycine receptor (anti-GlyR) antibodies both in the cerebrospinal fluid and in serum, which supplemented with the clinical presentation led to the diagnosis of PERM, presumably related to bladder cancer. The patient showed improvement and stabilization after treatment with intravenous immunoglobulin and chemotherapy against metastatic bladder cancer.
CONCLUSIONS: To the best of our knowledge, this is the first reported case of anti-GlyR antibody positive PERM related to urothelial carcinoma. The symptoms mimicked tetanus, and responded to chemotherapy and immunotherapy.

Among the patients seeking dental treatment, some may present with symptoms that cannot be resolved by dental treatment alone. Patients with orofacial symptoms associated with malignant diseases, which require medical treatment, often visit dental clinics for their initial consultation. Delays in making a definitive diagnosis worsen the patient\'s prognosis. Therefore, dental clinicians should also be aware of the signs and symptoms associated with malignant diseases. The chief complaints of these patients include numb chin syndrome (NCS), painless swelling of the palate and neck, trismus and temporomandibular disorders, and an enlarged tongue. This article aimed to review these orofacial symptoms and related diseases and describe representative cases of these diseases to obtain a definitive diagnosis via imaging. Panoramic radiograph is widely used in general dentistry, and this article reaffirmed the importance of panoramic radiograph anatomical landmarks in diagnosing the cases presented in this paper.

Background Temporomandibular joint ankylosis is a severe debilitating clinical condition where there is fusion of the mandible with the temporal bone. It is often a challenge to the maxillofacial surgeon as the surgical treatment protocol must be tailored individually according to the time of presentation of the ankylosis, and proper postoperative aggressive physiotherapy must be advocated, which is essential for a successful outcome. This is a case series of six recurrent temporomandibular joint ankylosis, in which the historical Esmarch surgery was done, and the pterygomassetric sling was interposed between the osteotomized segments. Postoperative mouth opening and surgical outcome were satisfactory. In our cases, we created a pseudojoint, which was very successful using the Esmarch procedure. Aim We aim to improve mouth opening in patients presenting with temporomandibular joint reankylosis using the Esmarch procedure and evaluate the efficacy of the conventional and modified Esmarch procedure. Materials and methods We have included six cases of recurrent temporomandibular joint reankylosis. Five cases were operated on using the conventional Esmarch procedure in which the osteotomy was done at the angle region, below the inferior alveolar nerve canal, and one case using the modified Esmarch procedure, wherein the osteotomy was done above the inferior alveolar nerve canal. The patients included in the case series presented with temporomandibular joint reankylosis and had undergone multiple surgeries for the release of ankylosis. Results Satisfactory postoperative mouth opening was achieved in all six patients. It was observed that in the modified Esmarch osteotomy, where the cuts were placed above the inferior alveolar nerve canal, there was a massive hemorrhage intraoperatively. This was primarily attributed to the altered anatomy of the maxillary artery, which was very close to the ankylotic mass. When the osteotomy was done below the inferior alveolar nerve canal, it was found that by this technique, the intraoperative hemorrhage was minimal, but it carries a risk of postoperative inferior alveolar nerve paresthesia, which was managed conservatively. Conclusion With the abovementioned results, we proceeded with the conventional Esmarch procedure for five cases and the modified Esmarch procedure for one case. It was found that in temporomandibular joint reankylosis cases, where there is extensive ankylotic mass extending from the glenoid fossa to the coronoid process of the mandible, this Esmarch procedure provides promising results when the osteotomy cuts are placed below the nerve canal.

Trismus can be the symptom of several diseases. For the most part, the inability to open the mouth is due to an articular disorder but occasionally, the cause may be extra-articular. In this case, being reported, non-articular hysterical trismus caused the jaw to lock in an 11-year-old boy for 3 months. During this period the jaw was completely locked and the locking was associated with moderate to severe pain. After three sessions of therapy the patient was able to open his mouth 33 mm and his eating was back to normal. Conversion disorders often present with dramatic physical presentation including trismus and jaw lock. This report highlights the importance of complete history taking and a thorough clinical examination to make a correct diagnosis in a patient with trismus.

Pericoronitis is a common disease that impacts the quality of life of individuals during the eruption of the third molars. Among the main clinical signs and symptoms reported were the presence of gingival operculum, pain, difficulty swallowing, and trismus with functional impairment. The present study shows a case report of pericoronitis treated with antimicrobial photodynamic therapy (aPDT), using a new oral formulation (INPI BR 1020170253902) of methylene blue. A female patient, 27 years old, presenting initial pericoronitis, had her pain, mouth opening, and swelling evaluated. She was submitted to a protocol of irrigation with sterile saline and photodynamic therapy using the new MB at 0.005% concentration and irradiation with low-intensity laser λ = 660 nm, 9 J per point, and radiant exposure of 318 J/cm2. The variables were evaluated on 4th day after aPDT. There was a 100% improvement in pain and an increase of 1,3 cm in mouth opening. There was no difference in the edema before and after aPDT using the new MB formula. Although the results are based on a single case report, suggest the hypothesis that aPDT using the new MB formula is an efficient therapy in the treatment of pain and trismus caused by the early stage of pericoronitis. Well-conducted randomized clinical trials are needed to compare this new formulation with conventional aPDT for further generalization of results.