Abstract
A case of tetanus in a patient with mandibular trismus is reported. The patient was a 58-yearold woman who was referred to our department. Cervical tetany with abnormal myotonus of the neck was present. Anteflexion and retroflexion were impossible. Except for a markedly elevated CPK level (468 IU/l), there were no laboratory abnormalities. Electromyography showed abnormal discharges in the masseter muscle, sternocleidomastoid muscle, paraspinal muscle, and trapezius muscle at rest. An intravenous dose of penicillin-G 1200000 units was administered on the day of admission and 3000 units of antitetanic human immunoglobulin was intravenously administered 4 days later. The patient was discharged 27 days later. A critical condition was prevented by initiating treatment for tetanus before the onset of generalized spasms. Electromyography was quite useful in establishing an early diagnosis of tetanus. Although rare, tetanus should be included in the differential diagnosis when treating patients who have trismus. Severe trismus associated with clenching is an important sign for dif f erenting of tetanus from other lesions.
