Botulinum Toxin A for Spastic Trismus Due to Brain Stem Encephalitis in a Pediatric Intensive Care Setting: A Unique Case Report

Abstract

Injection of botulinum toxin A to masseter and temporalis muscles improved mouth opening and facilitated suction and oral care in a child with spastic trismus. This is the first such report in a 3.5-year-old child on mechanical ventilator in pediatric intensive care unit setting.

Keywords

interincisal distance - suction - oral care - masseter - temporalis

• References

• 1 Freitag V, Schulz A. Trismus resulting from central nervous system lesion. J Maxillofac Surg 1976; 4 (04) 216-219
• 2 Fietzek UM, Kossmehl P, Barthels A, Ebersbach G, Zynda B, Wissel J. Botulinum toxin B increases mouth opening in patients with spastic trismus. Eur J Neurol 2009; 16 (12) 1299-1304
• 3 Ashford S, Turner-Stokes L. Goal attainment for spasticity management using botulinum toxin. Physiother Res Int 2006; 11 (01) 24-34
• 4 Lynne Turner-Stokes, Kings College, Univ of London, NHS. Goal Attainment Scaling. Available at: http://www.kcl.ac.uk/lsm/research/divisions/cicelysaunders/resources/tools/gas.aspx . Accessed December 2015
• 5 Jelasic F, Freitag V. Inverse activity of masticatory muscles with and without trismus: a brainstem syndrome. J Neurol Neurosurg Psychiatry 1978; 41 (09) 798-804
• 6 Krasnianski M, Gaul C, Neudecker S, Behrmann C, Schlüter A, Winterholler M. Yawning despite trismus in a patient with locked-in syndrome caused by a thrombosed megadolichobasilar artery. Clin Neurol Neurosurg 2003; 106 (01) 44-46
• 7 Ungar L, Sharma M, Zibly Z. Intrathecal baclofen pump implantation in a patient 2 years following a traumatic brain injury resulted in regained oratory capabilities. Neurol India 2015; 63 (04) 618-619
• 8 Sheean G. Botulinum toxin treatment of adult spasticity: a benefit-risk assessment. Drug Saf 2006; 29 (01) 31-48
• 9 Mor N, Tang C, Blitzer A. Temporomandibular myofacial pain treated with botulinum toxin injection. Toxins (Basel) 2015; 7 (08) 2791-2800
• 10 Quezada-Gaon N, Wortsman X, Peñaloza O, Carrasco JE. Comparison of clinical marking and ultrasound-guided injection of botulinum type A toxin into the masseter muscles for treating bruxism and its cosmetic effects. J Cosmet Dermatol 2016; 15 (03) 238-244
• 11 Bentsianov B, Francis A, Blitzer A. Botulinum toxin treatment of temporomandibular disorders, masseteric hypertrophy, and cosmetic masseter reduction. Oper Tech Otolaryngol--Head Neck Surg 2004; 15: 110-113
• 12 Ahn J, Horn C, Blitzer A. Botulinum toxin for masseter reduction in Asian patients. Arch Facial Plast Surg 2004; 6 (03) 188-191
• 13 Seo JH, Kim DK, Kang SH, Seo KM, Seok JW. Severe spastic trismus without generalized spasticity after unilateral brain stem stroke. Ann Rehabil Med 2012; 36 (01) 154-158
• 14 Spillane KS, Shelton JE, Hasty MF. Stroke-induced trismus in a pediatric patient: long-term resolution with botulinum toxin A. Am J Phys Med Rehabil 2003; 82 (06) 485-488