Background:

Trismus is a debilitating clinical condition characterized by restricted mouth opening that significantly affects speech, mastication, oral hygiene, airway management, and quality of life. Although temporomandibular joint (TMJ) disorders are frequently considered the primary cause, trismus may arise from a wide spectrum of infectious, inflammatory, traumatic, neoplastic, iatrogenic, and fibrotic conditions involving the oral cavity, maxillofacial region, and head and neck. Delayed recognition of non-TMJ causes can result in diagnostic errors and inappropriate treatment. This review highlights a systematic approach to the evaluation and management of trismus beyond TMJ pathology.

Methods:

A narrative review of current literature was performed using peer-reviewed publications, clinical practice guidelines, and standard textbooks in oral and maxillofacial surgery, otolaryngology, head and neck surgery, and rehabilitation medicine. Etiological factors, diagnostic strategies, imaging modalities, and evidence-based treatment options were synthesized to formulate a practical clinical management algorithm.

Results:

The principal non-TMJ causes of trismus include oral submucous fibrosis, odontogenic infections involving the masticator spaces, facial trauma, post-radiotherapy fibrosis, postoperative scarring, malignancies of the oral cavity and oropharynx, neurological disorders, and medication-induced muscle spasm. Clinical assessment should incorporate a detailed history, inter-incisal mouth opening measurement, cranial nerve examination, intraoral evaluation, and appropriate imaging such as panoramic radiography, computed tomography, or magnetic resonance imaging based on the suspected pathology. Management is directed toward the underlying cause and may include pharmacotherapy, physiotherapy, jaw mobilization exercises, management of infection, corticosteroids where indicated, surgical release of fibrosis, coronoidectomy, reconstruction, or oncologic treatment. Early multidisciplinary intervention significantly improves functional outcomes.

Conclusion:

Trismus should be considered a clinical sign rather than a diagnosis. A structured diagnostic approach that extends beyond TMJ disorders enables early identification of serious underlying pathology and facilitates timely, individualized management. Close collaboration among oral and maxillofacial surgeons, otolaryngologists, physiotherapists, oncologists, and rehabilitation specialists is essential to optimize patient outcomes.

Dr. Prachi Dwivedi is an Oral and Maxillofacial Surgeon currently serving as a Consultant at Sarvodaya Hospital, Mathura, India. She completed her Bachelor of Dental Surgery (BDS) and Master of Dental Surgery (MDS) in Oral and Maxillofacial Surgery from People's College of Dental Sciences & Research Centre, Bhopal. she has undergone specialized clinical training in Cleft Lip and Palate Surgery at the Meenakshi Cleft & Craniofacial Centre, Chennai, enhancing her expertise in the multidisciplinary management of craniofacial anomalies. Her clinical interests include maxillofacial trauma, oral oncology, oral pathology, temporomandibular joint disorders, oral submucous fibrosis, cleft lip and palate, dentoalveolar surgery, implantology, and reconstructive maxillofacial surgery. She has authored and co-authored several peer-reviewed scientific publications, including studies on multidisciplinary management of panfacial trauma, orthognathic surgery outcomes, maxillary unicystic ameloblastoma, pleomorphic adenoma of the cheek, and management of bilateral parasymphysis fractures in pediatric patients. An active participant in national and international scientific forums, Dr. Dwivedi is committed to advancing oral and maxillofacial surgery through clinical excellence, research, education, and interdisciplinary collaboration. She is passionate delivering comprehensive, evidence-based patient care