title: Severe Spastic Trismus without Generalized Spasticity after Unilateral Brain Stem Stroke.
abstract: A 62-year-old female patient diagnosed with left brain stem stroke 2 months ago was admitted to our clinic for rehabilitation. She had no generalized spasticity on both extremities, but could open her mouth only approximately 2 mm between her upper and lower teeth due to severe trismus. On needle electromyography, the left masseter muscle showed paradoxically increased muscle activity during mouth opening. We injected 50 units of type A botulinum toxin (Botox®) into the left masseter muscle, and 20 units into the left temporalis muscle with guidance of ultrasonography. The interincisal distance increased to 8 mm on the 3(rd) day after injection, and 9 mm on the 4(th) day. One month later, the interincisal distance increased to 14 mm. The increased interincisal distance was maintained for 13 months after injection, and the quality of hygienic care and compliance of oral stimulation therapy also improved.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul 156-755, Korea.
authors.forename: Jong-Hyun
authors.initials: JH
authors.lastname: Seo
authors.forename: Don-Kyu
authors.initials: DK
authors.lastname: Kim
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Kang
authors.forename: Kyung-Mook
authors.initials: KM
authors.lastname: Seo
authors.forename: Ju Won
authors.initials: JW
authors.lastname: Seok