拔牙後併發破傷風—病例報告

Tetanus Following Dental Extraction-Case Report

馮天民(Tian-Ming Feng) ； 朱水松(Swei-Song Chu) ； 胡克信(Ko-Hsin Hu)

《中華民國耳鼻喉科醫學雜誌》 37卷6期 (2002/10) Pp. 442-446

https://doi.org/10.6286/2002.37.6.442

摘要

破傷風是法定報告傳染病，病程猛爆且易致命。本科於2001年12月間，經歷1名70歲女性病患，主訴漸進性牙關緊閉及吞嚥困難已2天。入院前1個月有拔牙病史。住院後陸續出現頸部僵硬、臉部痙笑（risus sardonicus）、弓背、腹部僵硬等典型症狀。經診斷為破傷風。即行氣管切開術及注射人類破傷風免疫球蛋白（human tetanus immunoglobulin）、破傷風類毒素（tetanus toxoid）、metronidazole，並入加護病房做支持性治療。6週後病人恢復良好，已能正常生活。破傷風的傳染途徑以表皮創傷為主，與拔牙傷口有關的病例極為少見，且破傷風在台灣幾已絕跡，所以容易令人遺忘，但仍未完全根絕，故當病人主訴以牙關緊閉及吞嚥困難為主要表現時，耳鼻喉科醫師應將破傷風列為鑑別診斷。

關鍵字

破傷風 ； 牙關緊閉 ； 吞嚥困難

並列摘要

Tetanus is a notifiable communicable disease and its clinical course is fulminant and lethal. A 70-year-old female patient visited our out-patient clinic with chief presentation of progressive trismus and dysphagia for two days in December 2001. A history of dental extraction one month earlier was obtained. After admission, the patient subsequently exhibited rigid neck, risus sardonicus, arched back and rigid abdomen, etc. tetanus was then diagnose. The patient was managed with tracheostomy, injection of human tetanus immunoglobulin, tetanus toxoid, metronidazole and transferred to intensive care unit. The patient made a good recovery after six weeks. The major entry route of tetanus is a skin wound, and tetanus is rarely associated with dental extraction. In Taiwan, tetanus is a rare and somewhat forgotten disease, otolaryngologists should keep it in mind when trismus and dysphagia present.

並列關鍵字

tetanus ； trismus ； dysphagia