Case Report; Tetanus, Differential Diagnosis with Trismus

개구장애 환자에서의 감별진단, 파상풍 환자의 증례보고

  • Lim, Hyun-Dae (Department of Oral medicine, School of Dentistry, Wonkwang University & Wonkwang Dental research institue) ;
  • Lee, You-Mee (Department of Oral medicine, School of Dentistry, Wonkwang University & Wonkwang Dental research institue)
  • 임현대 (원광대학교 치과대학 구강내과학 교실 및 원광치의학 연구소) ;
  • 이유미 (원광대학교 치과대학 구강내과학 교실 및 원광치의학 연구소)
  • Received : 2011.03.11
  • Accepted : 2011.05.26
  • Published : 2011.06.30


Tetanus is fatal neurological disease caused by Clostridium tetani on contaminated wound that is characterised by muscle spasm, muscle pain, and autonomic dysfuction. C. tetani exist on contaminated wound frequently that developed clinical tetanus under low oxygen condition. Tetanus have four symptomatic form: generalized, localized, cephalic, and neonatal. The incubation period is about 7 days and mortality is high. The commonest presenting symptom is trismus and other is stiffness of neck and back(opisthotonos), muscle spasm, dysphagia, facial pain, risus sardonicus. Trismus is primary presenting symptom in 50~75% of the cases and this have high possibility of initial visit to dental office. This case report of a patient who visit in our department with trismus as chief complaint.


tetanus;mouth opening limitation;dysphagia;trismus


Supported by : 원광대학교


  1. Dhanrajani PJ. Jonaidel OJ. Trismus: Aetiology, differential diagnosis and treatment. Dent Update 2002;29:88-94.
  2. Hedderson SO, Mody T, Groth DE et al, The presentation of tetanus in an emergecy department. J Emerg Med 1998;16:705-708.
  3. St-Hilaire H, William D, Weber et al, Clinicopathologic conference: trismus following dental treatment. Oral surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:261-266.
  4. Wakasaya Y, Watanabe M, Tomiyama M et al. An Unusual case of chronic relapsing tetanus associated with mandibular osteomyelits. Inter Med 2009;48:1311-1313.
  5. Million A. Diagnosis, treatment, and prevetivtion of tetanus. Prim Care Update Ob/Gyns 1997;4:75-79.
  6. Thwaites CL. Tetanus. Curr Anaesth Crit Care 2005;16:50-57.
  7. Sun KO, Chan YW, Cheung RTF. Management of tetanus:a review of 18 cases. J Royal Socie Med 1994;87:135-137.
  8. Hsu SS, Groleau G. Tetanus in the emergency department: a current review. J emerg Med 2001;20:357-365.
  9. Zachariades N, Koumoura F, Komins C. Cephalic tetanus: reports of case. Br J Oral Maxillofac Surg 2003;41:338-339.
  10. Brauner JS, Vieira SR, Bleck TP. Changes in severe accidental tetanus mortality in the ICU during two decades in Brazil. Intensive Care Med 2003;28:930-935.
  11. Farr JJ, Yen LM, Cook T et al. Tetanus. J Neurol Neurosurg Psychiatry 2000;69:292-301.
  12. Paterson AW, Ryan W, Rao-Muigonda VV. Trismus: Or is it tetanus? A report of a case. Oral surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:437-441.
  13. Mallick IH, Winslet MC. A review of the Epidemiology, Pathogenesis and management of tetanus. Int J Surg 2004;2:109-112.
  14. Aydin K, Caylan R, Caylan R et al. Otolayngologic aspects of tetanus. Eur Arch Otorhinolaryngol 2003;260:52-56.
  15. Ross J, Murrant NJ (1992) Dysphagia as a major symptom of tetanus. J Laryngol Otol 106: 923-924
  16. Kazansew M, Browne B, Dawes P (1989) Tetanus presenting as dysphagia. J Laryngol Otol 103: 229-230.