A case of tetanus is reported. A 70-year-old man, who was a blacksmith, was referred to our hospital because of difficulty in mouth opening. Clinical examinations revealed severe trismus and severe stiffness of the masseter and sternocleidmastoid muscles, but there were no symptoms of TMJ disease or maxillofacial phlegmon. Multiple small wounds were seen on both palms. Blood examinations showed a marked increase in serum creatine phosphokinase activity. These findings led to the clinical diagnosis of tetanus.
The patient was admitted to the hospital immediately and received anti-tetanus serum and penicillin-G. A tracheotomy was performed because of holotetanus and dyspnea. He was discharged from on the 39th hospital day. There were no functional sequelae.
Tetanus often leads to death when early diagnosis and early treatment are not performed. It is important to keep the possibility of tetanus in mind when we treat patients who have difficulty in mouth opening.
