Morse H E, Kent J N, Rothschild H
J Oral Surg. 1978 Jun;36(6):462-6.
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.
该病例呈现出重症破伤风管理中固有的诸多困难。此外，它还展示了一种很少被考虑的治疗方式，即对于确诊破伤风且无明确感染途径的病例进行拔牙、牙龈清创和牙龈切除术。众所周知，牙周和根尖部位很容易形成厌氧病灶。在该病例中，破伤风梭菌的厌氧培养未成功，可能是因为从口腔部位进行厌氧转移存在固有困难以及该微生物极度苛求。通常，所有从破伤风康复的患者都能完全康复，没有任何残留缺陷。这里讨论的病例也是如此。从此病例可得出以下结论：对于任何不明原因牙关紧闭的病例都应考虑破伤风的诊断；应通过抗毒素积极治疗免疫缺陷并同时进行主动免疫疗程；并且应开始积极的对症治疗。该病例的治疗基础是气道管理、镇静、自主神经危象的治疗以及病原体的根除。结果是一名重症患者对治疗产生反应并从这种毁灭性疾病中完全康复。
