Annals of Rehabilitation Medicine

A Case of Cephalic Tetanus with Unilateral Ptosis and Facial Palsy: Dong Hyuk Seo, Dae Kyung Cho, Hee Chung Kwon, Tae Uk Kim; Ann Rehabil Med 2012;36(1):167-170. Published online February 29, 2012; DOI: https://doi.org/10.5535/arm.2012.36.1.167

Abstract
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Cephalic tetanus is defined as a combination of trismus and paralysis of one or more cranial nerves. Cranial nerves III, IV, VI, VII, and XII may be affected, but the facial nerve is most frequently implicated. A 64-year-old female visited hospital for left ptosis followed by facial palsy after a left forehead abrasion in a car accident. At nine days post injury, left ptosis developed, left facial palsy developed twelve days post injury, and at fifteen days post injury, trismus and dysphagia developed. The following day, there was progression of symptoms to generalized tetanus, such as dyspnea and generalized rigidity. Videofluoroscopic swallow study showed penetration and aspiration. We report a case of cephalic tetanus with ptosis, facial palsy, and dysphagia, which progressed to generalized tetanus.

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Tetanus
Önder Ergönül, Selin Kolsuz, J Peter Figueroa
The Lancet.2026; 407(10529): 716. CrossRef
Facial neuromuscular junctions and brainstem nuclei are the target of tetanus neurotoxin in cephalic tetanus
Federico Fabris, Stefano Varani, Marika Tonellato, Ivica Matak, Petra Šoštarić, Patrik Meglić, Matteo Caleo, Aram Megighian, Ornella Rossetto, Cesare Montecucco, Marco Pirazzini
JCI Insight.2023;[Epub] CrossRef
Cephalic Tetanus without Injury – A Rare Presentation of Tetanus
Ramanan B.B.V, Ajit Kumar Pegu, Anupam Dutta, Arjit Das, Sanchu T.K. Sreeraj
Journal of Evolution of Medical and Dental Sciences.2021; 10(20): 1555. CrossRef
Cephalic tetanus presenting with bilateral facial palsy
A Tahir, P Pokorny, N Malek
Scottish Medical Journal.2019; 64(3): 108. CrossRef
A Case of Cephalic Tetanus in an Elderly Patient with Trismus
Marilia Bernardes, Saberio Lo Presti, Kenneth Ratzan
Case Reports in Infectious Diseases.2018; 2018: 1. CrossRef
Cephalic tetanus as a differential diagnosis of facial nerve palsy
Yuki Kotani, Kenji Kubo, Satoko Otsu, Toshihide Tsujimoto
BMJ Case Reports.2017; 2017: bcr2016216440. CrossRef
Cephalic Tetanus Presenting With Trismus in an Intravenous Drug Abuser
Mehrdad Haghighi, Amirhossein Moghtader Mojdehi, Shiva Faridi
Archives of Clinical Infectious Diseases.2015;[Epub] CrossRef
Just a graze? Cephalic tetanus presenting as a stroke mimic
Anisha Doshi, Clare Warrell, Dima Dahdaleh, Dimitri Kullmann
Practical Neurology.2014; 14(1): 39. CrossRef
JUST A GRAZE?
Anisha Doshi, Dima Dahdalleh, Clare Warrell, Dimitri Kullmann
Journal of Neurology, Neurosurgery & Psychiatry.2013; 84(11): e2.159. CrossRef

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Long-term Follow-up of Idiopathic Facial Palsy.: Lee, Hyeong Il , Shin, Jeong Beom , Lee, Sang Jin , Jun, Po Sung , Kim, Kyeong Tae; J Korean Acad Rehabil Med 2005;29(6):602-607.

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Objective
The purpose of this study was to observe clinical characteristics and electrodiagnostic findings of idiopathic facial palsy and to follow up beyond 1 year after onset. Method: From February 2002 to July 2003 the authors analyzed 103 cases that could be followed up after 1 year since diagnosed as idiopathic facial palsy by electrodiagnostic study which was performed at approximately 2 weeks after the onset time. The patients were classified by House- Brackmann (H-B) facial nerve grading system on their first visits and followed up by telephone interview using H-B system. Treatment method, age, sex, medical history and symptoms were noted. In addition, the blink reflex, nerveconduction study and needle electromyography (EMG) were done. Results: When degree of degeneration (% degeneration) was greater than 90% at approximately 2 weeks after the onset or motor unit action potentials were not detected in at least one among the four tested muscles, patients did not gain satisfactory facial function after 1 year. Conclusion: Methods related to prognosis of idiopathic facial palsy were compared with side to side evoked potential amplitude and needle EMG. This methods would be helpful to explain its prognosis. (J Korean Acad Rehab Med 2005; 29: 602-607)

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The Correlation between Peripheral Facial Neuropathy and Oropharyngeal Dysfunction.: Ju, Sung Ryeol , Han, Jae Young , Choi, In Sung , Lee, So Young , Lee, Sam Gyu , Rowe, Sung Man , Park, Seung Jin; J Korean Acad Rehabil Med 2003;27(4):551-556.

Abstract

OBJECTIVE
To know the correlation between the grading of facial neuropathy by facial nerve conduction study (FNCS) and dysphagia severity by videofluoroscopic swallowing study (VFSS) in patients with acute peripheral facial palsy (PFP).
METHOD
Twenty patients with acute PFP were recruited for this study. The causes of acute PFP were limited to idiopathic Bell's palsy and Ramsay-Hunt syndrome. The time interval from the onset of PFP to study of FNCS and VFSS was 10 to 14 days. The severity of PFP was graded according to House-Brackmann facial nerve grade (H-B FNG). Percent degeneration grade (PDG) was determined by FNCS. Baseline-to-peak amplitude of compound muscle action potentials in orbicularis oris muscle was used as an evaluation parameter. Oral transit time (OTT), pharyngeal transit time (PTT), pharyngeal delay time (PDT) and dysphagia limit were obtained by VFSS. RESULTS: There was a significant correlation between PDG and H-B FNG. The severity of oropharyngeal dysfunction was increased as the severity of the PDG increases. Delayed OTT, delayed PDT, and/or reduced dysphagia limit were revealed as a presentation of oropharyngeal dysfunction in acute PFP.
CONCLUSION
The severity of PFP and oropharyngeal dysfunction were significantly correlated. And so we think that precise evaluation and adequate management of oropharyngeal dysfunction will be needed in acute PFP patients.

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