Tetanus--review of the literature and report of case.

This case presents many of the difficulties of management that are inherent in a severe case of tetanus. Also it shows a seldom-considered therapeutic modality, that of dental extraction, gingival debridement, and gingivectomy with a confirmed case of tetanus without an established portal of entry. It is well known that periodontal and periapical locations can easily give rise to an anaerobic focus. In this case, anaerobic culture of C tetani was unsuccessful, possibly because of the inherent difficulty of anaerobic transfer from an oral locus and the extreme fastidiousness of the organism. As a rule, all patients who recover from tetanus do so completely, without any residual deficit. This was true in the case discussed here. Conclusions that can be drawn from this case are the following: a diagnosis of tetanus should be considered in any case of unexplained trismus; aggressive treatment of the immunologic deficit by antitoxin should be instituted along with a course of active immunization; and aggressive symptomatic treatment should be started. The bases of the treatment of this case were management of airways, sedation, treatment of autonomic crisis, and eradication of the causative agent. The result was that a severely ill patient reponded to treatment and completely recovered from a devastating disease.