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Musculoskeletal and Soft-Tissue Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Tetanus itself is rare, but worldwide it is an important cause of death in parts of Asia, Africa and South America. The incubation time from injury to first symptoms ranges from 3 to 21 days (usually about 10 days).The most common symptoms are jaw stiffness (trismus), dysphagia, neck stiffness and abdominal and back pain. Hypertonia is found on examination.Localized or generalized painful spasms follow within 24–72 h, becoming more severe and prolonged from minimal stimuli.Death may occur from laryngospasm, respiratory failure or autonomic dysfunction.There is no rapid diagnostic test to prove the diagnosis, therefore admit a suspected case immediately to the intensive care unit (ICU).
Head and neck cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Trismus is a late complication of both surgery and radiotherapy and is due to fibrosis in and around the temporomandibular joint leading to restriction of jaw opening and closing. Osteonecrosis is a late complication of radiotherapy, usually affecting the mandible as the maxilla has a better blood supply. It can be precipitated by a dental infection or extraction many years after radiotherapy.
Infectious Diseases
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Vas Novelli, Delane Shingadia, Huda Al-Ansari
The most important factor that influences prognosis is the quality of the supportive care. Mortality is highest in the very young and the very old. A poor outcome is associated with the onset of trismus <7 days after injury, and with onset of generalised tetanic spasms <3 days after the onset of trismus. Case fatality rates for neonatal tetanus range from <10% with intensive care facilities to >75% without it.
Forget-me-not: Lemierre’s syndrome, a case report
Published in Journal of American College Health, 2023
Benjamin Silverberg, Melinda J Sharon, Devan Makati, Mariah Mott, William D Rose
Symptoms are somewhat nonspecific and include fever, rigors, odynophagia, difficulty swallowing, trismus, neck pain, and/or oropharyngeal swelling. (Of these, rigors and unilateral neck swelling represent red flags that may necessitate admission to the intensive care unit [ICU] and antibiotic coverage for anaerobes.) The tonsils do not necessarily appear exudative or ulcerated.17 Unilateral neck swelling and tenderness from thrombophlebitis of the IJV is often mistaken for cervical lymphadenopathy.16,17 The so-called "cord sign" is actually induration of the IJV under the anterior border of the SCM muscle.14,31 Evidence of thrombophlebitis can also be found with advanced imaging; a CT scan of the neck with contrast is the gold standard, but MRI or even ultrasound may be utilized.4,10,11,16,17,26,27,33 Workup does usually start with a plain chest X-ray, but this can be normal in a minority of cases.32 Myalgias, arthralgias, productive cough, hemoptysis, dyspnea, pleuritic chest pain, and abdominal pain are also possible.23,32
A prospective 5-year study of trismus prevalence and fluctuation in irradiated head and neck cancer patients
Published in Acta Oto-Laryngologica, 2022
Susan Aghajanzadeh, Therese Karlsson, My Engström, Lisa Tuomi, Caterina Finizia
Albeit results in this study indicate that trismus is a prevalent long-term complication, fluctuations in MIO were highlighted that have not in detail been described before, emphasizing that mouth opening ability is to some extent a dynamic process. The largest deterioration appeared to take place during the first six months following radiotherapy completion with MIO reductions of 9–10 mm equaling up to a 19% MIO reduction. Whilst the deteriorations from baseline to 3- and 6 months post-RT were statistically significant, no other fluctuations in MIO between time-points were. This early window of deterioration was also supported by Pauli et al, who concluded that the highest incidence of trismus at 38% was found at 6 months post-RT [6]. When comparing fluctuations in MIO and the number of patients whose MIO changed between time-points, it was observed that approximately one third of patients improved, deteriorated or remained unchanged between each follow-up from baseline to 12 months – changes that were statistically significant. However, no significant fluctuations in MIO occurred after 12 months post-RT, emphasizing that the first year following RT-completion is the most dynamic. Additionally, a total of 27% of patients who were free of trismus deteriorated to again fulfil the trismus criterion during the 5-year period further emphasizing a certain degree of fluctuation in the trismus condition. What caused this fluctuation is unknown but may be attributed to the fact that some patients have performed jaw exercises albeit in an unstructured manner.
Analysis of clinical characteristics and management of ectopic third molars in the mandibular jaw: a systematic review of clinical cases
Published in Acta Odontologica Scandinavica, 2021
Suresh Kandagal Veerabhadrappa, Priyadarshini Hesarghatta Ramamurthy, Seema Yadav, Ahmad Termizi Bin Zamzuri
The majority of EMTM teeth are diagnosed because of clinical signs and symptoms and only a few are incidentally discovered during routine radiographic examination [7]. Our review found that about 85% of the cases were symptomatic. The frequently observed signs and symptoms were swelling, pain, trismus, facial asymmetry, difficulty in mastication, purulent discharge, bad taste and temporomandibular joint dysfunctions. Infrequent symptoms included sinus opening [8,14,22], dysphagia [42], ear pain and deviation of mandible [24]. One EMTM reported having dental caries suggestive of displacement of a tooth into a sigmoid notch after its exposure to the oral cavity [28]. Few cases also reported prodromal symptoms such as fever with acute inflammation and enlargement of lymph nodes [23,45]. Thus, EMTM displays a wide range of symptoms which are common to other oro-facial pathologies which may lead to misdiagnosis of EMTM. The duration of clinical signs and symptoms varied from a few months to 7 years [16]. About 15% of the cases in the present review were found to be asymptomatic [15,25,33,34,36,40].