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1 R E V I E W Various trismus MIYAMOTO Ikuya OGAWA Atsushi OHASHI Yu KAWAI Tadashi YAMAYA Genki KOGI Shintaro TSUNODA Naoko KOMATSU Yuko ONODERA Kei YAMADA Hiroyuki Keyword : trismus, inflammation, tumor, temporomandibular joint, masticatory muscle In dental practice, we often encounter patients who present with difficulty in opening their mouths. Trismus not only interferes with dental treatment, but may also indicate a life-threatening and urgent general condition. Based on the etiology, trismus is classified into inflammatory, neoplastic, arthritic, traumatic, muscular, cicatricial, and neurological. Inflammatory trismus is the most common, followed by trismus due to TMJ disorders. In addition, there are various other potential causes; thus, it is necessary to diagnose and treat the cause accurately. If the results of the treatment for the initial diagnosis are not satisfactory, it is necessary to reassess the clinical symptoms and consider the possibility of a different disease. In order to provide safe and reliable dental treatment, it is necessary to diagnose the cause of the trismus and administer the appropriate treatment. はじめに 最大開口量と開口障害

2 R E V I E W 55.5mm 50.6mm 1 40mm 2 55mm 40mm 開口障害を惹起する代表的な疾患 3 Graft-versus-host disease (GVHD) 炎症性開口障害の診断 4 1 炎症性開口障害と治療 mm

3 CT 慢性炎症による開口障害 3 7 腫瘍性開口障害 CT MRI 3 5mm BP 4 ( ) 30mm

4 R E V I E W 関節性開口障害 II III IV mm 外傷性開口障害 mm

5 8 9 25mm CT 筋性開口障害 I 13 Square mandible 16 25mm 30mm 9 CT MRI

6 R E V I E W 10 GVHD 30mm 瘢痕性開口障害 GVHD 神経性開口障害 おわりに 1,,., , P9 guideline/guideline_treatment_tmj_2018.pdf

7 ,, CT ,, Miyamoto I, Ishikawa A, Morimoto Y, et al.: Potential risk of asymptomatic osteomyelitis around mandibular third molar tooth for aged people: a computed tomography and histopathologic study. PLoS one, 8: e73897, Dijkstra PU, Kalk WW, Roodenburg JL: Trismus in head and neck oncology: a systematic review. Oral Oncol, 40: , Miyamoto I, Togo Y, Osawa K, et al.: Surgical management of chondroblastoma involving the temporal bone and mandible: case report, Asian Journal of Oral and Maxillofacial Surgery, 23: 87-91, ,, ,, Zhi K, Ren W, Zhou H, et al.: Management of temporomandibular joint ankylosis: 11 years' clinical experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 108: , ,, ,, high perimandibular approarch Murakami K, Yokoe Y, Yasuda S, et al.: Prolonged mandibular hypomobility patient with a "square mandible" configuration with coronoid process and angle hyperplasia. Cranio, 18: , ,, ,, ,, ,, ,, Yoshida K: Surgical intervention for oromandibular dystonia-related limited mouth opening: Long-term followup. J Craniomaxillofac Surg, 45: 56-62,

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