• Kathleen S Spillane, Jean E Shelton, and Michael F Hasty.
• Department of Pediatric Physical Medicine and Rehabilitation, Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
• Am J Phys Med Rehabil. 2003 Jun 1; 82 (6): 485-8.

AbstractWe present a case of prolonged resolution of stroke-induced trismus after botulinum toxin A treatment in a 9 1/2-yr-old boy. The patient had an idiopathic right posterior fossa hemorrhage with resultant spastic quadriparesis, ataxia, dysarthria, and dysphagia. He developed right-sided trismus with only fair response to stretch. Several months after discharge, the patient had worsening trismus with an interincisal distance of only 0.4-0.7 cm and difficulty with oral hygiene and eating. The patient was treated with botulinum toxin A to the masseter muscles with minimal response. Four months later, he received botulinum toxin A to the bilateral masseter and temporalis muscles and to the right medial and lateral pterygoid muscles, with more improvement. His third and last botulinum toxin A treatment was to the bilateral masseter, temporalis, lateral, and medial pterygoid muscles in larger doses. He had an excellent response, maintaining an interincisal distance of 2.5 cm 1 yr later, with significant improvement in speaking and chewing.

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