Potential Role of Coronoidectomy for Stroke-Induced Spastic Trismus Patients with Botulinum Toxin Insensitivity: A Case Report

Paitoon Benjapornlert; Pimchanok Tuakta; Chalermpong Chatdokmaiprai; Thanaporn Thongjood

Authors

Paitoon Benjapornlert Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok
Pimchanok Tuakta Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok
Chalermpong Chatdokmaiprai Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok
Thanaporn Thongjood Department of Dentistry, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok

Keywords:

trismus, dysphagia, stroke, coronoidectomy, botulinum toxin

Abstract

Background: Trismus is a consequence of muscle spasticity, often secondary to stroke, leading to compromised oral functions and increased aspiration pneumonia risk. However, in some cases, the patient does not respond to conservative treatment such as rehabilitation procedures, medication, and botulinum toxin injection.

Objective: To evaluate the efficacy of coronoidectomy in managing spastic trismus unresponsive to conventional and botulinum toxin treatments post-stroke.

Case description: A 40-year-old man, with post right middle cerebral artery (MCA) infarction presented with spastic trismus, exhibiting an incisor gap of 1 cm. The patient remained non-responsive after receiving 25 units of botulinum toxin serotype A in the bilateral masseter muscles and consequently suffered an aspiration pneumonia episode. Computerized tomography (CT) imaging identified left temporomandibular joint (TMJ) ankylosis. A bilateral coronoidectomy and interposition gap arthroplasty on the left condyle expanded the mouth opening to 5 cm. Post-surgical management included intensive swallowing rehabilitation and a dental splint to preserve the achieved incisor gap.

Conclusion: Coronoidectomy can be a potential therapeutic intervention for stroke-induced trismus, particularly when non-responsive to conservative therapies.

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