rismus caus n adult A. Krishnan, %DS,a D. J. Sleeman, FDSRCPS, FRCS,b and 6. II. Irvine, FDSRCS, FRCS,c Bristol, England DEPARTMENT
OF
ORAL
AND
MAXILLOFACIAL
An unusual case of trismus caused by a retained
SURGERY,
SOUTHMEAD
HOSPITAL
foreign body in an adult is reported.
(ORAL SURC ORAL MED ORAL PATHOL 1992;73:546-7)
ndiagnosed foreign bodies in the head and neck are not uncommon in children. r However, no case of such a problem in an adult of normal intelligence has been reported. A case is reported in which a foreign body was found in the right submassetericspace.Becauseof the patient’s account of the incident and late onset of symptoms, the diagnosis and subsequent removal of the foreign body were delayed. CASEREPORT
A 4%year-oldman was referred with painlesstrismus. The trismuscommenced 3 weeksafter hewalkedinto a door with a ball-point penin hismouth.The patientclaimedthat the entire pen had beenremoved.Two weeksafter the injury a painful right facial swellingdeveloped,for which his physician prescribederythromycin and metronidazole.A weeklater the trismusbegan. Extraoral examination showedan ill-defined, painless swellingoverlying the right massetermuscle.Mandibular openingwas 3 mm. Intraorally, a well-definedfirm mass approximately 1 cm long could readily be palpatedin the right cheek.No abnormality wasseenon radiographicexamination. Intraoral surgical exploration with the patient under generalanesthesiarevealedthe cap of a ball-point pen situated betweenthe massetermuscleand the ramusof the mandible(Fig. 1). Removalof the cap proved difficult be-
SeniorHouseOfficer. bRegistrar. CConsultant. 7/12/33220
546
Fig. 1. Intraoral view showingball-point pen cap being removed.
causeof the markedfibrousreaction. After removalof the cap,the openingimprovedonly minimally despitemanipulation. However,during the next 3 monthsthe mouth opening slowlyreturnedto normalwith the helpof manipulation with wood sticks. DISCUSSION Undiagnosed intraoral foreign bodies are common in children and usually result when a patient falls with an object in the mouth.2 The resulting injury is usually a superficial mucosal tear that heals rapidly, provided no piece of the foreign body remains in situ. Any subsequentsymptoms in the area of injury must raise the suspicion of a remaining piece and should be investigated. Toranzo and Medina3 reported a
Retained foreign body
Volume ‘73 Number 5
similar case of rtrismw in a IO-year-old child, that also resulted frlom a retained ball-point pen cap. However, this cap was visible on x-ray film. The swelling and subsequent trismus in the present case were not immediately linked with the accident, because the patient was a healthy, intelligent adult who insisted that the balLpoint pen had been completely removed. We thank the Department of Medical Illustration for preparing the figure, and Mrs. E. de Eeaufort for typing the manuscript.
REFERENCES 1. Raine PAM, McLennan JG. Impaction of foreign body in palate. Br Med J 1984;289:879-80. 2. Haddad RY. An unusual hazard of toothbrushing. Br Dent J 1990;168:296-7. 3. Toranzo JM, Medina JA. Foreign body. ORAL SURG ORAL MED ORAL PATHOL 1989;67:227. Reprint
requests:
G. H. Irvine, FDSRCS, FRCS Department of Oral and Maxillofacial Surgery Southmead Hospital Westbury-on-Trym Bristol, U.K. BSlO 5NB
BOUND VOLUMES AVAILABLE TO SUBSCRIBERS Bound volumes of ORAL SURGERY,ORAL MEDICINE, AND ORAL PATHOLOGY are available to subscribers (only) for the 1991 issues from the Publisher, at a cost of $45.00 for domestic, $60.15 for Canadian, and $57.00 for international, for Vol. 71 (January-June) and Vol. 72 (July-December). Shipping charges are included. Each bound volume contains a subject and author index and all advertising is removed. Copies are shipped within 60 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Payment must (ICcompany all orders. Contact Mosby-Year Book, Inc., Subscription Services, 11830 Westline Industrial Drive, St. Louis, MO 63146-3318, USA, phone (800)325-4177, ext. 4351, or (3~14)453-4351. Subscriptions must be in force to qualify. tion.
Bound volumes
547
are not available
in place of a regular
journal
subscrip-
OF
ORAL
AND
MAXILLOFACIAL
An unusual case of trismus caused by a retained
SURGERY,
SOUTHMEAD
HOSPITAL
foreign body in an adult is reported.
(ORAL SURC ORAL MED ORAL PATHOL 1992;73:546-7)
ndiagnosed foreign bodies in the head and neck are not uncommon in children. r However, no case of such a problem in an adult of normal intelligence has been reported. A case is reported in which a foreign body was found in the right submassetericspace.Becauseof the patient’s account of the incident and late onset of symptoms, the diagnosis and subsequent removal of the foreign body were delayed. CASEREPORT
A 4%year-oldman was referred with painlesstrismus. The trismuscommenced 3 weeksafter hewalkedinto a door with a ball-point penin hismouth.The patientclaimedthat the entire pen had beenremoved.Two weeksafter the injury a painful right facial swellingdeveloped,for which his physician prescribederythromycin and metronidazole.A weeklater the trismusbegan. Extraoral examination showedan ill-defined, painless swellingoverlying the right massetermuscle.Mandibular openingwas 3 mm. Intraorally, a well-definedfirm mass approximately 1 cm long could readily be palpatedin the right cheek.No abnormality wasseenon radiographicexamination. Intraoral surgical exploration with the patient under generalanesthesiarevealedthe cap of a ball-point pen situated betweenthe massetermuscleand the ramusof the mandible(Fig. 1). Removalof the cap proved difficult be-
SeniorHouseOfficer. bRegistrar. CConsultant. 7/12/33220
546
Fig. 1. Intraoral view showingball-point pen cap being removed.
causeof the markedfibrousreaction. After removalof the cap,the openingimprovedonly minimally despitemanipulation. However,during the next 3 monthsthe mouth opening slowlyreturnedto normalwith the helpof manipulation with wood sticks. DISCUSSION Undiagnosed intraoral foreign bodies are common in children and usually result when a patient falls with an object in the mouth.2 The resulting injury is usually a superficial mucosal tear that heals rapidly, provided no piece of the foreign body remains in situ. Any subsequentsymptoms in the area of injury must raise the suspicion of a remaining piece and should be investigated. Toranzo and Medina3 reported a
Retained foreign body
Volume ‘73 Number 5
similar case of rtrismw in a IO-year-old child, that also resulted frlom a retained ball-point pen cap. However, this cap was visible on x-ray film. The swelling and subsequent trismus in the present case were not immediately linked with the accident, because the patient was a healthy, intelligent adult who insisted that the balLpoint pen had been completely removed. We thank the Department of Medical Illustration for preparing the figure, and Mrs. E. de Eeaufort for typing the manuscript.
REFERENCES 1. Raine PAM, McLennan JG. Impaction of foreign body in palate. Br Med J 1984;289:879-80. 2. Haddad RY. An unusual hazard of toothbrushing. Br Dent J 1990;168:296-7. 3. Toranzo JM, Medina JA. Foreign body. ORAL SURG ORAL MED ORAL PATHOL 1989;67:227. Reprint
requests:
G. H. Irvine, FDSRCS, FRCS Department of Oral and Maxillofacial Surgery Southmead Hospital Westbury-on-Trym Bristol, U.K. BSlO 5NB
BOUND VOLUMES AVAILABLE TO SUBSCRIBERS Bound volumes of ORAL SURGERY,ORAL MEDICINE, AND ORAL PATHOLOGY are available to subscribers (only) for the 1991 issues from the Publisher, at a cost of $45.00 for domestic, $60.15 for Canadian, and $57.00 for international, for Vol. 71 (January-June) and Vol. 72 (July-December). Shipping charges are included. Each bound volume contains a subject and author index and all advertising is removed. Copies are shipped within 60 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Payment must (ICcompany all orders. Contact Mosby-Year Book, Inc., Subscription Services, 11830 Westline Industrial Drive, St. Louis, MO 63146-3318, USA, phone (800)325-4177, ext. 4351, or (3~14)453-4351. Subscriptions must be in force to qualify. tion.
Bound volumes
547
are not available
in place of a regular
journal
subscrip-
