2007 Volume 53 Issue 10 Pages 608-612
Trismus is an early symptom of tetanus and commonly associated with maxillofacial injuries. A careful differential diagnosis is thus required for patients who have trismus after facial injuries. In this report, we present a case of tetanus with trismus after a facial injury.
A 62-year-old man sustained facial injury on April, 200X. On May, he consulted a surgeon because the trismus had worsened since May. After debridement and the administration of tetanus antitoxin to prevent tetanus, he was referred to our hospital and admitted for nutritional management. The first clinical diagnosis was facial injuries with traumatic arthritis of TMJ; the imaging findings revealed no maxillofacial fractures or head and neck phlegmon. On the next day, tetanus was diagnosed on the basis of progressive trismus, and tetanus antitoxin was administered. On May, he was transferred to Osaka Prefectural Senri Critical Care Medical Center, and artificial ventilation was instituted under sedation. His condition improved with intravenous administration of antibiotics and by controlling tonic convulsions. On June I, he revisited our hospital for rehabilitation. Finally, he was discharged on July.
It is important to consider the possibility of tetanus when examining patients with trismus, particularly after injury.