患者吴××,男性,22岁,工人.1992年10月2日不慎跌伤,(?)牙冠折断,同时伴有张口疼痛和张口受限,但无颌面部皮肤损伤,故当时未作任何处理.10月8日因张口受限未见好转并有加剧趋势而在当地医院就诊,检查发现（?）冠折,叩诊(+),张口度2.0cm,张口无疼痛,两侧颞下颌关节无弹响,双侧髁状突压痛,但无肿胀,两侧下颌骨、颞下颌关节摄片无殊,拟诊:1.创伤性颞下颌关节功能紊乱;2.(?)冠折.给予局部封闭加理疗,仍未见效,于10月9日来我院口腔科就诊.检查:张口度1.5cm,张口时两侧咀嚼肌群酸痛,并有颈部不适,屈颈试验阴性,双侧髁状突压痛(±),但无明显肿胀.详细询问病史,患者于5天前左脚踝部皮肤不慎被铁皮划破,出血,疼痛,未作处理.检查:左脚踝部有一3cm划痕,已结痂.拟诊:1.破伤风;2.(?)冠折.转外科治疗.患者于当天夜间即出现“苦笑”面容,颈项强直,头后仰,不能点头,讲话含糊不清,肌肉酸胀感,行走困难.即给予补液、抗炎、TAT静滴.10月10日检查患者精神软,颈项强直,克氏征(-),双肘屈曲向内,腹肌背肌紧张, Patient Wu XX, male, 22 years old, worker .On October 2, 1992 accidentally fell, (?) Crown fracture, accompanied by mouth pain and mouth limited, but no maxillofacial skin damage, so at that time October 8 due to restricted mouth did not improve and there is an increasing trend in the local hospital, check found (?) Coronal, percussion (+), mouth opening 2.0cm, mouth no pain, both sides Temporomandibular joint no bombs, bilateral condylar tenderness, but no swelling, mandible on both sides, temporomandibular joint radiograph without special symptoms: 1. Traumatic temporomandibular joint dysfunction; 2. (?) Crown Fold to give local closed plus treatment, still not effective, to our hospital stomatology clinic on October 9. Check: mouth opening 1.5cm, mouth when chewing muscles pain on both sides, and neck discomfort, negative test of flexion , Bilateral condylar tenderness (±), but no obvious swelling.Detailed history, the patient in the left ankle skin inadvertently was scratched 5 days, bleeding, pain, untreated.Check: there is a left ankle 3cm scratches, scab has been diagnosed: 1. Tetanus; 2. (?) Crown fold. Turn surgical treatment. Patients in the day that night there is “smile” face, stiff neck, head back, can not nod, talk vague Clear, muscle soreness, difficulty walking, that is given rehydration, anti-inflammatory, TAT intravenous .10 on the 10th check the patient soft spirit, neck stiffness, Kirschner sign (-), elbows buckling inward, tension,