Editing Tetanus (section)

=== Cephalic tetanus ===
Cephalic tetanus is the rarest form of the disease (0.9–3% of cases),<ref name=doshi >{{cite journal | vauthors = Doshi A, Warrell C, Dahdaleh D, Kullmann D | title = Just a graze? Cephalic tetanus presenting as a stroke mimic | journal = Pract Neurol | volume = 14 | issue = 1 | pages = 39–41 | date = February 2014 | pmid = 24052566 | doi = 10.1136/practneurol-2013-000541 | s2cid = 32389452 }}</ref> and is limited to muscles and nerves in the head.<ref name=morales >{{cite journal | vauthors = Del Pilar Morales E, Bertrán Pasarell J, Cardona Rodriguez Z, Almodovar Mercado JC, Figueroa Navarro A | title = Cephalic tetanus following penetrating eye trauma: a case report | journal = Bol Asoc Med P R | volume = 106 | issue = 2 | pages = 25–9 | date = 2014 | pmid = 25065047 }}</ref> It usually occurs after trauma to the head area, including: [[skull fracture]],<ref name=adeleye >{{cite journal | vauthors = Adeleye AO, Azeez AL | title = Fatal tetanus complicating an untreated mild open head injury: a case-illustrated review of cephalic tetanus | journal = Surgical Infections | volume = 13 | issue = 5 | pages = 317–20 | date = October 2012 | pmid = 23039234 | doi = 10.1089/sur.2011.023 }}</ref> laceration,<ref name=adeleye /> eye injury,<ref name=morales /> [[dental extraction]],<ref name=ajayi >{{cite journal | vauthors = Ajayi E, Obimakinde O | title = Cephalic tetanus following tooth extraction in a woman from Nigeria. | journal = J Neurosci Rural Pract | volume = 2 | issue = 2 | pages = 201–2 | date = July 2011 | pmid = 21897694 | pmc = 3159367 | doi = 10.4103/0976-3147.83597 | doi-access = free }}</ref> and [[otitis media]],<ref name="pmid23468033">{{cite journal | vauthors = Ugwu GI, Okolugbo NE | title = Otogenic tetanus: case series | journal = West Afr J Med | volume = 31 | issue = 4 | pages = 277–9 | date = 2012 | pmid = 23468033 }}</ref> but it has been observed from injuries to other parts of the body.<ref name="pmid23346010">{{cite journal | vauthors = Kwon JC, Park Y, Han ZA, Song JE, Park HS | title = Trismus in cephalic tetanus from a foot injury | journal = Korean J. Intern. Med. | volume = 28 | issue = 1 | pages = 121 | date = January 2013 | pmid = 23346010 | pmc = 3543954 | doi = 10.3904/kjim.2013.28.1.121 }}</ref> Paralysis of the [[facial nerve]] is most frequently implicated, which may cause lockjaw, [[Bell's palsy|facial palsy]], or [[Ptosis (eyelid)|ptosis]], but other cranial nerves can also be affected.<ref name=ajayi /><ref name=seo >{{cite journal | vauthors = Seo DH, Cho DK, Kwon HC, Kim TU | title = A case of cephalic tetanus with unilateral ptosis and facial palsy | journal = Ann Rehabil Med | volume = 36 | issue = 1 | pages = 167–70 | date = February 2012 | pmid = 22506253 | pmc = 3309317 | doi = 10.5535/arm.2012.36.1.167 }}</ref> Cephalic tetanus may progress to a more generalized form of the disease.<ref name=doshi /><ref name=seo /> Due to its rarity, clinicians may be unfamiliar with the clinical presentation, and may not suspect tetanus as the illness.<ref name=morales /> Treatment can be complicated, as symptoms may be concurrent with the initial injury that caused the infection.<ref name=adeleye /> Cephalic tetanus is more likely than other forms of tetanus to be fatal, with the progression to generalized tetanus carrying a 15–30% case fatality rate.<ref name=doshi /><ref name=adeleye /><ref name=seo />