Dysphagia Rehabilitation for a Tetanus Patient with Sustained Mandibular Trismus and Dysphagia after the Remission of the Spasmodic Contraction

Abstract

We report a case of a 69-year-old male patient with severe dysphagia and trismus secondary to tetanus. The patient was treated with anti-tetanus immunoglobulin, penicillin G and metronidazole immediately after he was hospitalized and a tracheotomy was performed to prevent possible aspiration. On the 12th hospital day, a speech therapist (ST) started providing non-swallowing exercises: jaw-opening exercises, stretching the neck muscles, and thermal tactile stimulation to the faucial pillars. The rigidity on the suprahyoid muscles and jaw-opening muscles were remitted by the 31st day; however, dysphagia and mild trismus remained as a risk of aspiration, in which video fluorography showed mid- and post-swallowing aspiration. Additional non-swallowing exercises were provided: the tongue holding maneuver, the Mendelsohn maneuver, and a strengthening exercise for the neck muscles, and a swallowing exercise with jelly also started afterwards. The patient returned to a regular diet on the 49th day and was discharged on the 52nd day with complete improvement of dysphagia and trismus. The appropriate and intensive interventions, including dysphagia rehabilitation by the ST from the early stage of the disease, appeared to have contributed to preventing pulmonary complications in the patient.