title: Tongue piercing. The new "rusty nail"?
abstract: BACKGROUND
  Cephalic tetanus is a rare form of the tetanus caused primarily by wounds or other infectious processes involving the head and neck. This condition frequently progresses to the generalized form of tetanus with the attendant risks and complications.
  
  
  METHODS
  A case report of a young female who developed an unusual form of tetanus after a tongue piercing is presented here. We discuss this disorder as it applies to the contemporary caregiver with a focus on its presentation and recognition.
  
  
  RESULTS
  A delay in diagnosis of 13 days from presentation occurred. The patient had a slow, uneventful but incomplete recovery course. She never developed significant airway compromise, nor did she demonstrate any evidence of hemodynamic instability but continued to have right facial weakness up to 6 months after discharge.
  
  
  CONCLUSIONS
  A few factors were identified that contributed to the significant delay in diagnosis. The unusual nature of the disease and a lowered index of suspicion on the part of the initial caregivers were probably the major causes. Fortunately, no major adverse sequelae resulted from the delay. However, if this case heralds the onset of a rise in the incidence of tetanus, early recognition and diagnosis would seem essential to avoid much of the morbidity and mortality associated with the disease.
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania Medical Center, 5 Ravdin Building, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
authors.forename: O
authors.initials: O
authors.lastname: Dyce
authors.forename: J R
authors.initials: JR
authors.lastname: Bruno
authors.forename: D
authors.initials: D
authors.lastname: Hong
authors.forename: K
authors.initials: K
authors.lastname: Silverstein
authors.forename: M J
authors.initials: MJ
authors.lastname: Brown
authors.forename: N
authors.initials: N
authors.lastname: Mirza
mesh_terms: D000328:Adult; D003389:Cranial Nerve Diseases / Q000175:diagnosis*; D004576:Electromyography; D005260:Female; D006801:Humans; D011677:Punctures / Q000009:adverse effects*; D013742:Tetanus / Q000209:etiology*; D014059:Tongue / Q000293:injuries*; D014313:Trismus / Q000175:diagnosis