I am hoping for some advice.I apologise in advance for the length of this posting.

I had ameloblastic carcinoma of my maxilla diagnosed in 2000 followed by a partial maxillectomy. The cancer was completely removed in this first major op but I was left with quite severe trismus. This meant that it is almost impossible to take a good impression to give me a comfortable obdurator. I have been to Guy's Dental Prosthetics department and although they could make an obdurator I was still unable to get it into my mouth . My brilliant consultant, has tried so many different ways to correct my OAF surgically and I have also had several operations to try to correct the trismus. In January this year I had a free flap graft taken from my wrist but due to complications which resulted in 24 hours in ICU this has now failed. My trismus is even worse now - I can't even get one finger into my mouth. This is causing me problems eating and cleaning my teeth and I also am having problems when swallowing with the food """going down the wrong way""" - quite frightening sometimes as I really feel that I am going to choke.

Do you have any suggestions as to how to improve the trismus? I use tongue depressors which did give me some improvement immediately after the maxillectomy, but now don't seem to be having any effect.

I didn't have any radiotherapy and the trismus has been caused purely by scar tissue from the surgeries.

Thanks in advance

Jan

Dear Jan
Your problem raises three issues which I will try to address.
(1) Regarding your limited mouth opening, my surgical colleague says that your problem certainly sounds like soft tissue scarring. He suspects that there will be a tight scar band from the failed free flap and maybe some temporalis muscle shortening. If it is possible to release the scar surgically, immediate post operative and mandatory lifelong physiotherapy stretching exercises using a therabite could prevent relapse. The Therabite device costs about £200 each but is light years ahead of tongue depressors and trismus screws.
(2) Maxillary obturators can be made in two parts. This allows the separate parts to be inserted into the mouth more easily. See slide 20 in Online Presentation
(3) Even though you can't open your mouth wide, you must still take good Care of the Mouth and Teeth . The link given leads to good advice. It is easier to prevent tooth decay (caries) and gum disease (periodontitis) than to treat it!
Best wishes
Vinod

This message has been edited. Last edited by: Dr Vinod K Joshi,

Vinod,
Thank you for your input. The trismus started initially following the maxillectomy and I have had at least 5 operations to try to improve the situation (I am starting to lose count ), including those you mentioned plus removal of a sliver of bone from the joint. It did improve somewhat but following the free flap it has deteriorated again. The muscle which goes between the top and bottom jaw (just in front and below my ear - sorry don't know it's """proper""" name)is a solid band of tissue now with no stretch to it at all.

I have read about the Therabite but I know I couldn't afford to buy it (I am also disabled and can't work) but I will mention it to my consultant, especially as I don't feel I could face any more surgery now as I have already had 14 operations to date.

The main problem with the obdurator is that the doctors cannot even get an impression done now. They tried yesterday with a very flat, soft tray but even though they got the tray in, the battle to remove it again totally destroyed the impression! I had visions of me walking around with a tray in my mouth for the foreseeable future . I think I am going to be referred to the Queen Victoria Hospital in East Grinstead to see if they have any different ideas.

I definitely do have problems cleaning my teeth now and use an electric toothbrush for the bits I can reach easily, a baby's toothbrush for the inner side my teeth and also use a mouthwash regularly. I have regular appointments at my dentist too.

Thanks for your help.

Jan