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Severe Spastic Trismus without Generalized Spasticity after Unilateral Brain Stem Stroke.
Jong-Hyun Seo1, Don-Kyu Kim, Si Hyun Kang
1Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul 156-755, Korea.
Annals of Rehabilitation Medicine
|April 17, 2012
Summary
Botulinum toxin (Botox) injections effectively treated severe trismus in a stroke patient. This treatment improved mouth opening, aiding oral hygiene and therapy compliance for over a year.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Medical Aesthetics
Background:
- Brain stem stroke can lead to severe motor deficits, including trismus (jaw muscle spasm).
- Trismus significantly impairs oral hygiene and rehabilitation therapy, impacting patient recovery.
- Limited treatment options exist for post-stroke trismus, necessitating innovative therapeutic approaches.
Purpose of the Study:
- To evaluate the efficacy of botulinum toxin type A injections for treating severe trismus post-brain stem stroke.
- To assess the duration of therapeutic effects and impact on oral function and hygiene.
Main Methods:
- A 62-year-old female patient with post-stroke trismus underwent ultrasonography-guided injections.
- 50 units of botulinum toxin type A (Botox) were administered to the left masseter muscle, and 20 units to the left temporalis muscle.
- Needle electromyography confirmed paradoxical masseter muscle activity during attempted mouth opening.
Main Results:
- Interincisal distance increased from 2 mm to 8 mm by day 3 and 9 mm by day 4 post-injection.
- Mouth opening improved to 14 mm one month after treatment.
- The enhanced mouth opening was sustained for 13 months, improving oral hygiene and therapy adherence.
Conclusions:
- Botulinum toxin type A injections are a safe and effective treatment for severe trismus following brain stem stroke.
- This intervention offers sustained improvement in jaw mobility, facilitating better oral care and rehabilitation outcomes.
- Ultrasonography guidance ensures precise toxin delivery, maximizing therapeutic benefits and minimizing risks.
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