Overview
Cephalic tetanus refers to localized tetanus affecting the upper body, often involving muscles of the neck and upper extremities, leading to significant muscle spasms and contractures 2.Diagnosis
Clinical presentation includes localized muscle spasms and rigidity, particularly in the masseter, sternocleidomastoid, trapezius, and levator scapulae muscles 2.
No specific diagnostic tests; diagnosis is clinical based on history and physical examination 2.Management
First-line treatment: Conventional antitoxin therapy and supportive care including muscle relaxants and sedation 2.
Adjunctive treatment: Botulinum toxin A for persistent muscle contractures; dosing varies by muscle group (e.g., 75IU for sternocleidomastoid, 25-50IU for trapezius and levator scapulae) 2.Special Populations
Elderly: Case report indicates effective use of botulinum toxin A in an 80-year-old patient with persistent contractures 2.Key Recommendations
Initiate conventional antitoxin therapy and supportive care for patients diagnosed with cephalic tetanus (Evidence: Expert opinion 2).
Consider botulinum toxin A injections for management of persistent muscle contractures following initial conventional treatment (Evidence: Weak 2).
Monitor and manage elderly patients with cephalic tetanus closely, as they may benefit from targeted interventions like botulinum toxin A (Evidence: Expert opinion 2).References
1 Panerai AE. Physiopathology of cephalic pain: where are we?. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 2015. link
2 García-García A, Gándara-Rey JM, Crespo-Abelleira A, Jorge-Barreiro J. Botulinum toxin A for treating muscular contractures in cephalic tetanus. The British journal of oral & maxillofacial surgery 2007. link