Muscle Spasm Case Studies

Patient was a 53-year-old female with jaw pain. Patient states that she cannot open her mouth more than 2.5cms due to muscle spasm in her jaw region. Patient attributes this to an injection given in the back of her mouth to fill a hole in her tooth that is thought to have formed due to receiving chemotherapy and radiation as a young age which caused them not to form properly. On the day of filling, patient had soreness in mouth and limited motion due to pain and irritation. On day two, patient struggled to open mouth during eating and yawning was moderately to highly painful. Day 5 came and symptoms only worsened to the point of barely being able to open wide enough to fit a toothbrush into her mouth. On day 7 she called the doctor and was

On day 11 she saw the oral surgeon and was diagnosed with temporary trismus, also known as lock jaw, due to spasm of the muscles that perform mastication and was instructed to use a warm compress and perform manual stretching 4+ times per day. Patient has no history of jaw issues besides occasional clicking when chewing especially hard or a lot as in the case of a rare steak or chewing gum. Patient had ewing sarcoma bone cancer in 1970 at the age of 6 with treatment consisting of high dose chemotherapy and radiation. Cancer has not returned since, however multiple surgeries have been performed to remove benign tumors from her parathyroid, gallbladder, adrenal glands, and soft tissue. She also suffers from circulation and skin issues in her right forearm and hand due to radiation and lymphedema. Patient takes multiple medications per day to prevent infections in her arm and hand as well as daily

This questionnaire included 10 sections in which the patient chose on a scale of 0 to 4 their level of impairment with each level having a description. These included: communication (talking), normal living activities (brushing teeth/flossing), normal living activities (eating, chewing), social/recreational activities, non-specialized jaw activities (yawning, mouth opening), sexual function, sleep, effects of any form of treatment, tinnitus, and dizziness. The two pages were then added together and a percent disability was calculated. While this questionnaire has been used in multiple studies on TMD, one study by Cleland and Palmer notes that there is a lack of reliability and validity testing for this questionnaire by Steigerwald and Maher while 2 others stated the lack of research into the validity of the TMD Disability Index as a limitation. Therefore, I cannot make any conclusion regarding the sensitivity, specificity, or minimal detectable change necessary for this specific questionnaire and whether the patient’s results show improvement. According to the questionnaire, the patient reported with a 35% disability upon the initial filling of it out and with a 15% disability three weeks later. Based on the patient’s written reporting she was doing much better, however, without studies of the questionnaire itself I am hesitant to make conclusions regarding