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Clinical Challenge | Radiology

A Woman With Trismus QUIZ

Michael Ferra, MD1; Peter D. Costantino, MD2,3,4; Deborah Shatzkes, MD5
[+] Author Affiliations
1Department of Radiology, Lenox Hill Hospital
2Department of Otolaryngology–Head and Neck Surgery, Lenox Hill–Manhattan Eye, Ear, and Throat Hospital, New York, New York
3The North Shore–LIJ Hofstra School of Medicine, Hempstead, New York
4New York Head and Neck Institute, New York
5Head & Neck Radiology, Department of Radiology, Lenox Hill Hospital, New York, New York
JAMA Otolaryngol Head Neck Surg. 2015;141(7):665-666. doi:10.1001/jamaoto.2015.0722.
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A woman in her 50s developed severe trismus several months after treatment of a dental abscess. Approximately 10 years after onset of symptoms, she was seen by an oral surgeon who attempted mandibular release via a cervical incision, but the operation was unsuccessful. There was no other significant medical or surgical history. On physical examination, severe trismus was present with maximal interdental distance of 1 mm. What is the diagnosis?

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Figure.

A-C, Noncontrast computed tomographic images. A, Axial slice from an image of the facial bones. B, Coronal slice from an enhanced scan of the facial bones. C, Coronal image of the facial bones using a soft-tissue algorithm. Asterisk indicates left medial pterygoid artery. D, Three-dimensional reconstructed image of the facial bones.

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