JAPANESE JOURNAL OF ORAL & MAXILLOFACIAL SURGERY

Vol. 53 No. 10                   2007

ISSN: 0021-5163      UBIC: 151-J

ABSTRACT

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 30, 200X. On May 10, he consulted a surgeon because the trismus had worsened since May 7. 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 12, 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 2, he revisited our hospital for rehabilitation. Finally, he was discharged on July 9. It is important to consider the possibility of tetanus when examining patients with trismus, particularly after injury. Key words: tetanus, trismus, facial injury

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