{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T08:03:11Z","timestamp":1768032191604,"version":"3.49.0"},"reference-count":10,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,1,5]]},"abstract":"<jats:p>Cephalic tetanus is defined as a combination of trismus and paralysis of one or more cranial nerves. Since it is a rare cause of facial nerve palsy, it is often overlooked as a differential diagnosis. We present the case of a 75-year-old man admitted to our emergency department with left facial nerve palsy, left ptosis and dysphagia 2\u2005weeks after a head laceration. Soon after admission, he was orally intubated because of massive aspiration. A delayed diagnosis of cephalic tetanus was reached only when he was extubated and trismus and risus sardonicus were identified in addition to facial nerve palsy. The patient was re-intubated and successfully extubated on day 20 postadmission. In orally intubated patients, trismus and risus sardonicus may be overlooked, and although rare, cephalic tetanus should be considered to be a differential diagnosis of facial nerve palsy.<\/jats:p>","DOI":"10.1136\/bcr-2016-216440","type":"journal-article","created":{"date-parts":[[2017,1,20]],"date-time":"2017-01-20T11:25:55Z","timestamp":1484911555000},"page":"bcr2016216440","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Cephalic tetanus as a differential diagnosis of facial nerve palsy"],"prefix":"10.1136","volume":"2017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9532-2859","authenticated-orcid":false,"given":"Yuki","family":"Kotani","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Kubo","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoko","family":"Otsu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshihide","family":"Tsujimoto","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,1,20]]},"reference":[{"key":"2025082702325359000_2017.jan20_1.bcr2016216440.1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599813506835"},{"key":"2025082702325359000_2017.jan20_1.bcr2016216440.2","first-page":"997","article-title":"Bell's palsy: diagnosis and management","volume":"76","author":"Tiemstra","year":"2007","journal-title":"Am Fam Physician"},{"key":"2025082702325359000_2017.jan20_1.bcr2016216440.3","doi-asserted-by":"publisher","DOI":"10.1016\/0735-6757(88)90049-6"},{"key":"2025082702325359000_2017.jan20_1.bcr2016216440.4","doi-asserted-by":"publisher","DOI":"10.4103\/0972-2327.83092"},{"key":"2025082702325359000_2017.jan20_1.bcr2016216440.5","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.48.3.290"},{"key":"2025082702325359000_2017.jan20_1.bcr2016216440.6","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2013-000541"},{"key":"2025082702325359000_2017.jan20_1.bcr2016216440.7","doi-asserted-by":"publisher","DOI":"10.5535\/arm.2012.36.1.167"},{"key":"2025082702325359000_2017.jan20_1.bcr2016216440.8","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2011.55"},{"key":"2025082702325359000_2017.jan20_1.bcr2016216440.9","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1097\/CNQ.0b013e3182542de3","article-title":"Retrospective review of the reduction of oral pressure ulcers in mechanically ventilated patients: a change in practice","volume":"35","author":"Zaratkiewicz","year":"2012","journal-title":"Crit Care Nurs Q"},{"key":"2025082702325359000_2017.jan20_1.bcr2016216440.10","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2009311"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-216440","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:33:04Z","timestamp":1756287184000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-216440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1,20]]},"references-count":10,"alternative-id":["10.1136\/bcr-2016-216440"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-216440","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1,20]]}}}