파상풍과 저작근 강직

Tetanus and masticatory muscle spasm

Tetanus is a rare disease which is caused by the exotoxin produced by Clostridium tetani. The exotoxin affects the central nervous system and its main site of action is the interneuronal synapses of the inhibitory pathways where it induce a blockade of spinal inhibition resulting in muscular rigidity. Tetanus may occur when the microorganisms are introduced not ony through wouds that provide anaerobic conditions but also without obvious portal of entry. The incubation period of tetanus varies from three days to four weeks(usually about seven days). Generally, patients with tetanus show early trismus due to the masseteric spasm with varying degree of hypertonicity of the muscles in the neck, back, abdomen and limbs. The spasms of the facial muscles result in risus sardonicus and spasm of spinal musculature causes opisthotonus. Spasms can by precipitated by all forms of stimuli such as noise, light and touch. Recently we encountered three cases of tetanus in 35-, 40-, and 54-year-old male. Their initial presentations were trismus with or without dyspnea. Subsequently, they developed muscular spasm which led to the diagnosis of tetanus, This paper reports these relatively unusual cases with the general description about tetanus and the management of the condition.