破傷風の診断に直接至らなかった開口障害の1例

概要

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The incidence and mortality rate of tetanus have declined because of the development of vaccines, but tetanus remains a serious disease and can be fatal if treatment is delayed. We describe our experience with a case of tetanus in a 44-year-old man who visited our hospital because of trismus. The forcible mouth opening range was 5 mm. Although there was no apparent paralysis or dysesthesia, the patient complained of shoulder stiffness. When we contacted the patient four days after the initial examination, he experienced difficulty in walking. The patient was thus brought him to the emergency room of our hospital immediately. Tetanus was suspected on the basis of symptoms of dorsomesial rigidity in addition to trismus and a history of trauma involving his finger. Debridement of the affected area and tracheostomy to prevent possible dyspnea were immediately performed, and treatment with antitetanic human immunoglobulin was started. The patient's condition was managed in the ICU by sedation and artificial ventilation in a dark room. On day 45 after the initial examination, remission of muscle rigidity was achieved, and the artificial ventilator was removed. The patient was discharged on day 73.
Japanese Society of Oral and Maxillofacial Surgeonsの論文