Teaching Video NeuroImages: Cephalic tetanus: Not every facial weakness is Bell palsy

A 54-year-old Brazilian woman with unknown immunization status presented with unilateral facial weakness and trismus 1 week after facial trauma. Examination revealed left frontal laceration, left upper and lower facial weakness, and trismus (figure and video). CT of the head and face were unremarkable. She was diagnosed with cephalic tetanus and treated with tetanus immunoglobulin and active vaccination, metronidazole, and supportive care. The wound was debrided and 2 wooden foreign bodies were collected.

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