Brain Neurorehabil.  2012 Mar;5(1):39-42. 10.12786/bn.2012.5.1.39.

Effect of Botulinum Toxin A on Trismus after Pons Infarction: A case report

• Oh SJ
• Im S
• Oh J
• Hong SH
• Park GY

• KMID: 1965897
• DOI: http://doi.org/10.12786/bn.2012.5.1.39

Abstract

We report a 77-year-old woman with bilateral pons infarction who presented with severe trismus, which was responsive to botulinum toxin-A injection. She was unable to open her mouth and showed anterior displacement of her temporo-mandibular (TM) joint on MRI findings. She was fed via nasogastric tube because of mouth opening limitation. There was no improvement of her mouth opening after range of motion exercise. She underwent closed reduction of the TM joints under general anesthesia but there was no significant improvement. Electromyography studies revealed continuous muscle activities on masseter and temporalis muscles during mouth opening. Botulinum toxin-A (Botox(R)) was injected into both the masseter and left temporalis muscles under ultrasonographic guidance. There was some improvement in mouth opening at post-injection 5 days. The inter-incisal distance improved gradually, and she could start oral feeding after 18 days. She could maintain an inter-incisal distance of 1.8 cm with favorable response during post-injection 4 months.

Keyword

botulinum toxin; infarction; trismus

MeSH Terms

Aged
Anesthesia, General
Botulinum Toxins
Displacement (Psychology)
Electromyography
Female
Humans
Infarction
Joints
Mouth
Muscles
Pons
Range of Motion, Articular
Trismus
Botulinum Toxins

Figure

• 

  Fig. 1 Brain MRI. Diffusion weighted imaging (DWI) shows an acute ischaemic lesion at pons. Arrow represents bilateral pons infarction

• 

  Fig. 2 Pre-botulinum toxin A injection state, inter-incisal distance was 0.6 cm on active mouth opening (A), 18 days after botulinum toxin injection, inter-incisal distance was 1.8 cm on active mouth opening (B).

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  Fig. 3 MRI shows the anterior displacement of the temporomandibular joint. Arrow represents condyle and arrow head represents mandibular fossa.

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