[Dysphagia] Trismus?

[OTTO at email.chop.edu (Staci Otto)]

19 month old female now s/p her 2nd resection of a posterior fossa mass.
S/p trach, G-J tube.  Considerable deficits.  Bilateral vocal cord
paralysis. Damage to CN's II, III, VI, VIII, IX, X.   Complications from
both resections include hydrocephalus, infections, and an arrest- 
of immediate concern her jaw is tightly shut, yet there is no
constriction of the muscles involved in jaw closure- ??  She has NO
swallow.  Does not open her jaw when she has emesis.  Cannot get in to
do oral hygiene.  I work to get back to the tmj to get some release,
better in prone, but is extremely difficult to get any movement and I
dont want to force.
Any suggestions? Cautions? 

I know, your probably wondering- I'm not sure of her prognosis.  The
docs say "reasonable"- definitely not incurable status.  That is, if she
doesnt get pneumonia first.

Staci Otto MS CCC-SLP
Children's Hospital of Philadelphia
215-590-7636