Medical expert of the article
New publications
Contracture of the lower jaw: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Contracture of the lower jaw (Latin contrahere - to tighten, to contract) is a sharp limitation of mobility in the temporomandibular joint due to pathological changes in the soft tissues surrounding it and functionally associated with it.
Often, contracture of the lower jaw is combined with intra-articular adhesions (i.e. with ankylosis).
[ What causes jaw contracture?
Contracture of the lower jaw occurs due to changes in the skin, in the subcutaneous tissue surrounding the joint, in the masticatory muscles, in the fascia (parotid-temporal), in the nerve fibers of traumatic or inflammatory origin.
Coarse fibrous and bone adhesions of the anterior edge of the mandibular branch or its coronoid process with the zygomatic arch or maxillary tubercle may occur after gunshot and non-gunshot injuries to the temporal, zygomatic and buccal regions, as well as after erroneous injection of solutions (alcohol, formalin, acids, hydrogen peroxide, etc.), causing necrosis of the soft tissues around the jaw at the injection site. After necrosis, normal tissues are replaced by cicatricial ones.
Contractures due to prolonged adynamia of the head of the lower jaw with intermaxillary fastening of fragments of the lower jaw can be supplemented by the formation of scars in the thickness of the cheeks or lips if the soft tissues of the face were damaged simultaneously with the jaw fracture.
Neurogenic contracture of the lower jaw can develop due to reflex-painful contraction of the masticatory muscles (caused by pericoronitis, osteomyelitis, muscle injury with a needle during anesthesia), spastic paralysis and hysteria.
Symptoms of contracture of the lower jaw
In case of contracture of the lower jaw, a more or less pronounced reduction of the jaws is always observed. If it is based on acute inflammation of the masticatory muscles (trismus due to myositis), attempts to forcibly spread the jaws cause pain.
In case of persistent cicatricial and bone adhesions, the jaws may be brought together particularly significantly, but an attempt to separate them in this case is not accompanied by acute pain. Palpation can sometimes reveal coarse cicatricial contractions throughout the oral vestibule or in the retromolar region, in the area of the zygomatic bone, and the coronoid process.
In cases where the injury or inflammatory process occurred in an adult, there is no outwardly noticeable gross facial asymmetry, as well as no changes in the shape of the branch, condylar process, angle and body of the lower jaw. If the disease developed in childhood or adolescence, then by the time of examination (in an adult), the doctor may detect (clinically and radiographically) gross anatomical abnormalities: underdevelopment of the branch and body of the jaw, displacement of its chin section to the affected side, etc.
Where does it hurt?
What do need to examine?
Treatment of contracture of the lower jaw
Treatment of mandibular contractures should be pathogenetic. If the mandibular contracture is of central origin, the patient is referred to the neurological department of the hospital to eliminate the main etiologic factor (spastic trismus, hysteria).
In case of its inflammatory origin, the source of inflammation is first eliminated (the causative tooth is removed, the phlegmon or abscess is opened), and then antibiotic, physiotherapy and mechanotherapy are carried out. The latter is preferably carried out using the devices of A. M. Nikandrov and R. A. Dostal (1984) or D. V. Chernov (1991), in which the source of pressure on the dental arches is air, i.e. a pneumatic drive, which in the collapsed state has a thickness of 2-3 mm. D. V. Chernov recommends bringing the working pressure in the tube inserted into the patient's oral cavity within 1.5-2 kg/cm2 both in conservative treatment of cicatricial-muscular contracture and in its inflammatory etiology.
Contractures of the lower jaw caused by extensive bone or bone-fibrous adhesions, adhesions of the coronoid process, anterior edge of the branch or cheek are eliminated by excision, dissection of these adhesions, and those caused by the presence of narrow cicatricial contractions in the retromolar region - by the method of plastic surgery with counter triangular flaps.
After the operation, in order to prevent skin flap wrinkling and scarring under it, it is necessary, firstly, to leave a medical splint in the mouth (together with a stens insert) for 2-3 weeks, removing it daily for oral hygiene. Then make a removable denture. Secondly, in the postoperative period it is necessary to carry out a number of measures to prevent contracture recurrence and strengthen the functional effect of the operation. These include active and passive mechanotherapy, starting from the 8th-10th day after the operation (preferably under the guidance of a methodologist).
For mechanotherapy, you can use standard devices and individual devices that are made in a dental laboratory. This is discussed in more detail below.
Physiotherapeutic procedures (Bucca ray irradiation, ion galvanization, diathermy) are recommended to help prevent the formation of coarse postoperative scars, as well as lidase injections in case of a tendency towards cicatricial contraction of the jaws.
After discharge from the hospital, it is necessary to continue mechanotherapy for 6 months - until the final formation of connective tissue in the area of the former wound surfaces. Periodically, in parallel with mechanotherapy, a course of physiotherapy should be carried out.
Upon discharge, it is necessary to provide the patient with the simplest devices - means for passive mechanotherapy (plastic screws and wedges, rubber spacers, etc.).
Excision of fibrous adhesions, osteotomy and arthroplasty at the level of the base of the condylar process using a de-epidermized skin flap
The same operation at the level of the lower edge of the zygomatic arch with excision of the bone-scar conglomerate and modeling of the head of the lower jaw, interposition of the skin de-epidermized flap
Dissection and excision of soft tissue scars from the oral cavity; resection of the coronoid process, elimination of bone adhesions (with a chisel, drill, Luer nippers); epidermization of the wound with a split skin flap
Dissection and excision of cicatricial and bone adhesions through external access, resection of the coronoid process. In the absence of scars on the skin - surgery through intraoral access with mandatory transplantation of a split skin flap
Excision of the entire conglomerate of scars and bone adhesions through an intraoral approach to ensure wide mouth opening; transplantation of a split-thickness skin flap. The external carotid artery is ligated before the operation
Dissection and excision of bone and fibrous adhesions of the cheek to ensure wide opening of the mouth and closure of the resulting defect with a Filatov stem previously transplanted to the cheek or elimination of the cheek defect with an arterialized skin flap
Good results in the treatment with the above-described methods were noted in 70.4% of patients: the mouth opening between the front teeth of the upper and lower jaws varied within 3-4.5 cm, and in some individuals it reached 5 cm. In 19.2% of people, the mouth opening was up to 2.8 cm, and in 10.4% - only up to 2 cm. In the latter case, a repeat operation had to be performed.
The reasons for recurrence of contractures of the lower jaw are: insufficient excision of scars during surgery, use (for epidermization of the wound) of a thin epidermal flap rather than a split one A.S. Yatsenko-Tiersh; necrosis of part of the transplanted skin flap; insufficiently active mechanotherapy, ignoring the possibilities of physiotherapeutic prevention of the occurrence and treatment of cicatricial contractions after surgery.
Relapses of contractures of the lower jaw occur more often in children, especially in those operated not under general anesthesia or potentiated anesthesia, but under regular local anesthesia, when the surgeon fails to perform the operation according to all the rules. In addition, children do not follow the instructions for mechano- and physiotherapy. Therefore, it is especially important for children to perform the operation itself correctly and to prescribe coarse food after it (crackers, bagels, lollipops, apples, carrots, nuts, etc.).