Severe limitation in mouth opening following transtemporal neurosurgical procedures: diagnosis, treatment, and prevention.

Five new patients and six previously described patients with severe limitation in maximum mouth opening following transtemporal neurosurgical procedures are described. Six patients underwent an operation for epidural hematoma and three for skull-base meningloma; two were treated with a pterional craniotomy for an aneurysm. Limited maximum mouth opening in these circumstances is caused by temporal muscle scarring and shortening. Aggressive physiotherapy is potentially beneficial if started early. If, however, diagnosis is delayed, the efficacy of physiotherapy declines, and surgical treatments such as temporal muscle detachment and coronoidectomy are fully indicated. The differential diagnosis, prevention, and treatment of limited maximum mouth opening following neurosurgical procedures are discussed.