A Case Report of Tetanus Patient Showing Trismus and Dysphagia as Early Symptoms

  • Jang, Seo-Hee (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Byun, Jin-Seok (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Jung, Jae-Kwang (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Choi, Jae-Kap (Department of Oral Medicine, School of Dentistry, Kyungpook National University)
  • Received : 2020.09.07
  • Accepted : 2020.09.10
  • Published : 2020.09.30


Tetanus is a fatal disease caused by the infection Clostridium tetani found in animal feces and soil. It is a vaccine-preventable disease and rarely occurs in developed countries. However, approximately 30 cases still occur annually in South Korea. Tetanus, commonly called lockjaw, cause contraction of the masseter muscles in the early stage, resulting in trismus as the first symptom. As it progresses, spasm extends to various muscles in the face, neck, shoulder, and back, leading to distorted facial expression, dysphagia, backward arching of the body, dyspnea, and even death. Early diagnosis of tetanus is critical because it can quickly become fatal if left untreated. We present a case of trismus caused by tetanus and emphasize the importance of early diagnosis of acute trismus.


  1. Schiavo G, Matteoli M, Montecucco C. Neurotoxins affecting neuroexocytosis. Physiol Rev 2000;80:717-766.
  2. Masuyer G, Conrad J, Stenmark P. The structure of the tetanus toxin reveals pH-mediated domain dynamics. EMBO Rep 2017;18:1306-1317.
  3. Giannini L, Maccari A, Chiesa V, Canevini MP. Trismus, the first symptom in a challenging diagnosis of tetanus. BMJ Case Rep 2016;2016:bcr2015213897.
  4. Cook TM, Protheroe RT, Handel JM. Tetanus: a review of the literature. Br J Anaesth 2001;87:477-487.
  5. Kyu HH, Mumford JE, Stanaway JD, et al. Mortality from tetanus between 1990 and 2015: findings from the global burden of disease study 2015. BMC Public Health 2017;17:179.
  6. Scully C. Trismus. In: Scully C, ed. Oral and maxillofacial medicine: the basis of diagnosis and treatment. 3rd ed. St. Louis: Elsevier Health Sciences; 2013. pp. 167-169.
  7. Dijkstra PU, Huisman PM, Roodenburg JL. Criteria for trismus in head and neck oncology. Int J Oral Maxillofac Surg 2006;35:337-342.
  8. Thomas F, Ozanne F, Mamelle G, Wibault P, Eschwege F. Radiotherapy alone for oropharyngeal carcinomas: the role of fraction size (2 Gy vs 2.5 Gy) on local control and early and late complications. Int J Radiat Oncol Biol Phys 1988;15:1097-1102.
  9. Dhanrajani PJ, Jonaidel O. Trismus: aetiology, differential diagnosis and treatment. Dent Update 2002;29:88-92, 94.
  10. Okeson JP. Diagnosis of tempormandibular disorders. In: Okeson JP, ed. Management of temporomandibular disorders and occlusion. 8th ed. St. Louis: Elsevier Health Sciences; 2019. pp. 223-258.
  11. Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. 8th ed. Washington, DC: Department of Health & Human Services, Public Health Foundation; 2005.
  12. Weng WC, Huang WY, Peng TI, et al. Clinical characteristics of adult tetanus in a Taiwan medical center. J Formos Med Assoc 2011;110:705-710.
  13. Surana S, Tosolini AP, Meyer IFG, Fellows AD, Novoselov SS, Schiavo G. The travel diaries of tetanus and botulinum neurotoxins. Toxicon 2018;147:58-67.
  14. Hassel B. Tetanus: pathophysiology, treatment, and the possibility of using botulinum toxin against tetanus-induced rigidity and spasms. Toxins (Basel) 2013;5:73-83.
  15. Yen LM, Thwaites CL. Tetanus. Lancet 2019;393:1657-1668.
  16. Pascual FB, McGinley EL, Zanardi LR, Cortese MM, Murphy TV. Tetanus surveillance--United States, 1998--2000. MMWR Surveill Summ 2003;52:1-8.
  17. World Health Organization (WHO). Tetanus (total) reported cases [Internet]. Geneva: WHO; c2020. [cited 2020 Jul 15]. Available from:
  18. Korea Centers for Disease Control and Prevention (KCDC). Infectious disease portal [Internet]. Cheongju: Korea Centers for Disease Control and Prevention (KCDC); c2020 [cited 2020 Jul 11]. Available from:
  19. Perez-Fernandez J, Marin-Garcia G, Rodriguez-Vega G. Tetanus. In: Hidalgo J, Woc-Colburn L, eds. Highly infectious diseases in critical care. Cham: Springer; 2017. pp. 203-212.