Cephalic Tetanus in a Nontraumatized Patient with Left Facial Palsy

Yanagi, Fumiharu; Sawada, Noriko; Nishi, Masaaki; Nakayama, Ryosuke; Imamura, Shigehiro; Higashi, Kiichiro

doi:10.1097/00000539-199608000-00038

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…Since C tetani is widely distributed in the environment, tetanus can be acquired through injuries like a scratch, which is generally not recognized. Similar to our case, Ryu et al [12] and Yanagi et al [13] reported cases of tetanus that did not have any history of injury. Lee et al [14] reported that the most common causes of tetanus infection are open wound injury (48.2%), sting by foreign body (29.6%), unknown (11.1%), and cesarean operation (5.6%).…”

Section: Discussionsupporting

confidence: 88%

Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea

2019

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Rationale: Tetanus is caused by a neurotoxin (tetanospasmin) secreted by a spore forming gram-positive, anaerobic rod-shaped motile bacillus, Clostridium tetani . The most common symptoms of tetanus are trismus (100%), dysphagia (70.5%), dysarthria (35.2%), and neck stiffness (29.4%). Respiratory failure, laryngeal spasm, seizure, chest pain, nausea/vomiting, opisthotonus, back pain, and rigid abdominal wall can also be observed during progression of the disease. However, there has been no report of periocular discomfort as an initial manifestation after endoscopic sleep surgery in a patient with tetanus. Here, we report a patient who underwent endoscopic sleep surgery with a concurrent diagnosis of tetanus infection presenting with atypical periocular discomfort as the initial symptom. Patient concerns: A 63-year-old man complaining of sleep apnea, snoring, and daytime sleepiness visited our department. He subsequently underwent sleep surgery (anterior pharyngoplasty with tonsillectomy, septoplasty, microdebrider-assisted inferior turbinoplasty, and an endoscopic sinus surgery) for the treatment of his newly diagnosed obstructive sleep apnea. After 3 weeks of surgery, he visited the outpatient clinic of our department with right side periocular discomfort. Diagnoses: Four days after presenting with periocular discomfort, he was diagnosed with tetanus by presenting trismus, jaw pain, dysphagia, and ptosis at an emergency department of a different hospital. Interventions: Tetanus immunoglobulin and antibiotics were administered. Outcomes: His symptoms then resolved after a month without sequelae. Lessons: Although periocular discomfort is atypical and is not uncommon after nasal and oral surgeries, care should be taken when patients present with periocular pain because it could be a rare initial symptom of tetanus.

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Section: Discussionsupporting

confidence: 88%

Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea

2019

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“…It is becoming unrecognized, especially in localized forms (in particular cephalic) [ 6 , 7 ]. The gateway is a facial sore (even a puncture), chronic otitis media, or a dental or oral lesion [ 8 ]. In our case, it was an erosive cheilitis.…”

Section: Discussionmentioning

confidence: 99%

Cephalic Tetanus Presenting as Peripheral Facial Palsy: A Case Report

Hamdi¹,

Afellah²,

Ridal³

et al. 2023

Cureus

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Tetanus is a serious disease that has become rare in countries that adopt an effective and sustainable vaccination strategy; however, tetanus remains a fairly common problem in developing countries. The diagnosis of tetanus is fairly easy. However, its cephalic form is a rare but potentially life-threatening neurological condition caused by the bacteria Clostridium tetani, which can result in symptoms such as spasms, rigidity, and paralysis of various muscles and nerves in the head and neck region.This article is about a 43-year-old man who had presumed an idiopathic facial palsy at the beginning and who turned out after the evolution of the clinical picture that it is cephalic tetanus. In this article, we will see the subtleties and clinical elements that have allowed us to rectify the diagnosis. Peripheral facial palsy can be a presenting symptom of cephalic tetanus and should be considered in patients with a history of tetanus infection or exposure. Early recognition and prompt treatment of cephalic tetanus are crucial in preventing complications and improving outcomes. Treatment typically involves the administration of tetanus immunoglobulin and antibiotics, as well as supportive care for any associated symptoms or complications.

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A case of cephalic tetanus with facial nerve palsy as an initial symptom in an elderly patient

Nishikawa¹,

Kodama²,

Shimohata³

et al. 2009

Jpn. J. Oral. Maxillofac. Surg.

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Cephalic tetanus is a subtype of tetanus, which is associated with cranial nerve palsies and occurs in 1 ％ to 3 ％ of tetanus cases. We present a case of cephalic tetanus in an elderly patient with facial nerve palsy as an initial symptom. The patient was a 75-year-old man who had injured his face during gardening. Nine days after the injury, trismus with right facial nerve palsy occurred. Twelve days after the facial injury, he visited our hospital and was admitted immediately. He had severe fatigue, facial nerve palsy, severe trismus, and scabbing and induration at the lesion. CT examination revealed no characteristic findings, such as a fracture or dental infection, except for wood-chip-like materials in the injured area. After that, frequent tonic spasms of the legs occurred, and cephalic tetanus was diagnosed. The spasms developed to general convulsions, and the patient received respiratory care with sedation and tracheal intubation in the ICU. The latency period of tetanus was 9 days, and the onset period was about 84 hours. Chronic obstructive pulmonary disease resulted in severe ventilator-associated pneumonia. In the fourth stage of tetanus, the patient was asked to do mouth-opening exercises and deglutition exercises, and occlusion reconstruction was also performed. He recovered from cephalic tetanus and was discharged from the hospital on day 119 after the onset of disease.

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Cephalic Tetanus in a Nontraumatized Patient with Left Facial Palsy

Cited by 3 publications

References 6 publications

Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea

Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea

Cephalic Tetanus Presenting as Peripheral Facial Palsy: A Case Report

A case of cephalic tetanus with facial nerve palsy as an initial symptom in an elderly patient

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