Figure 1 - uploaded by Lalee Varghese
Content may be subject to copyright.
Swelling involving anterior two-thirds of the tongue and the floor of mouth, reaching up to the palate superiorly
Source publication
Acute lingual swelling is a potentially life threatening clinical condition which is encountered very rarely, the differential diagnosis of which includes hemorrhage, infarction, abscess, tumor and edema. Herein we report a case of lingual abscess that presented with acute tongue swelling and respiratory distress after extraction of lower two incis...
Context in source publication
Context 1
... physical examination, the patient was found to have mild stertor in the upright position. He was unable to close his mouth and there was drooling of saliva. A nontender, tense, fluctuant swelling involving the entire anterior two-thirds of the tongue and the floor of mouth, reaching up to the palate superiorly and occluding the view of the rest of oropharynx, was seen [ Figure 1]. The overlying mucosa was mildly congested. A flexible laryngoscope could not be negotiated beyond the nasopharynx. The total white blood cell count was mildly elevated at 11 500 per cu.mm with 72% neutrophils. Contrast-enhanced CT scan of the tongue and neck showed a hypodense lesion with peripheral enhancement within the substance of the anterior 2/3 of tongue occluding the airway [ Figure 2]. The differential diagnoses considered were lingual abscess, resolving lingual Acute lingual abscess is a rare, potentially life-threatening infection of the base or anterior part of the tongue, usually secondary to trauma or spread of infection from adjacent teeth and tonsils. Traumatic causes include accidental injury, injury by jagged teeth adjacent to the tongue, tongue-piercing, foreign bodies, fracture of the mandible and, rarely, following surgery to the tongue, teeth, or septum. [1] Cases of lingual abscess secondary to lingual tonsillar lesions and infected thyroglossal duct cysts have also been reported. [2] In some cases, the cause is not immediately apparent. [1] Despite being subject to constant trauma and exposure to many potential pathogens, the tongue is relatively immune to infection. This could be due to constant mobility of the tongue, which helps saliva that bathes it to produce a continuous cleansing effect. The thick layer of keratinized mucosa of the tongue is not easily penetrated by microorganisms. The tongue muscle with its rich vascular supply and lymphatic drainage also prevents infection. The immunological properties of saliva provide a further barrier to invasion by microorganisms. Any breach in mucosa of the tongue either by drugs or trauma predisposes to tongue infections which can become severe. [3] hematoma, lingual malignancy, and infected congenital lingual ...
Similar publications
Purpose
The objective of this systematic review was to assess the three-dimensional changes in bone tissue after immediate installation of a single implant in a fresh extraction socket in the anterior maxilla.
Methods
After defining a strategy, an electronic search was carried out using the databases PubMed, Embase, LILACS, Web of Science, Cochran...
OBJECTIVE: To compare the efficacy of Halstead and Vasirani Akinosi block techniques in achieving mandibular anesthesia during exodontia among subjects reporting to Watim Teaching Hospital. STUDY DESIGN: Randomized controlled trial. PLACE AND DURATION OF STUDY: This study was conducted in the department of Maxillofacial Surgery, Watim Dental Hospit...
Introduction: The aim of this study was to evaluate the quality and quantity of postoperative sleep following routine (nonsurgical) dental extraction. Materials and Methods: Participants with the indication of one- or two-teeth extractions under local anesthesia (n = 274) (experimental group) and the control group without any surgical intervention...
The aim of this research work is to evaluate the use of 980 nm diode laser in clotting the blood in the bone socket after tooth extraction. The
objective is to prevent possible clot dislodgement which is a defect that may lead to possible infection.
Material and methods: A number of rabbits were irradiated using 980 nm CW mode diode laser, 0.86W po...
Background: To investigate the middle-term effect on bone remodeling of different timings for different implant placement (immediate versus delayed). Methods: Patients with an anterior maxillary failing tooth were treated by single-crown supported by dental implant. Subjects were retrospectively analyzed for 3 years and assigned to one of two predi...
Citations
... Laboratory tests are an imperative assessment when an abscess is suspected, but it is worth stressing that these can be delayed when a malignancy is the primary suspicion. Notwithstanding, in our review, only rarely did patients have a clear leukocytosis with neutrophilic predominance: in the majority of cases in which it was specified, the white blood cell count remained under 12 × 10 9 /L [2,8,13,15,20,22]. Analogously, only a small increase in inflammatory markers was found in many patients [7,16,20]. ...
... In the other case, a tracheostomy under local anesthesia was preventively performed to allow for safe ventilation [15]. The concern for the airway patency led to the execution of a tracheostomy in the other four cases (one was described as emergent) [15,22,29]. The particular danger that is intrinsic to a posterior localization is made clear in the report by Schweigert et al. [1]: an unsuccessful intubation was attempted and the patient suffered irreversible cardiac arrest due to hypoxia during the tracheostomy. ...
... Any clinician having to face a patient with these difficult features must therefore consider a subtle-presenting abscess in the differential diagnosis, and immediate evaluation by an otorhinolaryngologist, together with a course of broad-spectrum empiric antibiotics and proper imaging, is advised. While appropriate medical therapy can avoid further extension of the disease, and even treat more localized infections such as cellulitis (which is often a differential diagnosis), imaging is in fact fundamental, both for the formulation of diagnostic hypotheses and to direct therapeutic management [22]. CT can thus be insufficient for differential diagnosis and many artifacts (e.g., metal dental materials) can hinder proper visualization of the disease [6]. ...
Simple Summary
Even if tongue abscesses are rare, they have very heterogeneous clinical, laboratory and radiological findings. In some cases, their presentation can be particularly nuanced, and they can easily be mistaken for a submucosal malignancy, leading to a dangerous delay in diagnosis. The present paper presents a review of the literature on the possible manifestations (including symptoms, clinical and laboratory findings, imaging) and the management of tongue abscesses in relation to the differential diagnosis of oral tumors.
Abstract
Tongue abscesses are rare conditions that usually follow mucosal disruption due to mechanical trauma or foreign body impaction. They typically manifest abruptly as a rapidly growing, hard mass or swelling in the context of tongue muscles; the patient frequently complains of pain, difficulties in swallowing or speaking, and fever. Nonetheless, the features of its presentation, together with accurate clinical evaluation, blood tests, and appropriate imaging tests, are usually sufficient to easily discern a tongue abscess from a malignancy. However, in rare cases, they may occur with slowly progressing and subtle symptoms, nuanced objective and laboratory findings, and inconclusive radiological evidence, leading to difficult differential diagnosis with submucosal malignancy. Herein, we review the literature, available on Pubmed, Embase, and Scopus, on publications reporting tongue abscesses, with atypical presentation suggesting an oral tumor. Our review confirms that tongue abscesses may manifest as a slowly growing and moderately painful swelling without purulent discharge and minimal mucosal inflammation; in this case, they may constitute an actual diagnostic challenge with potentially severe impact on correct management. Atypical tongue abscesses must therefore be considered in the differential diagnosis of tongue malignancy with submucosal extension, even when other diagnostic elements suggest a neoplasia; in this case, a deep biopsy under general anesthesia is essential for differential diagnosis, and simultaneous drainage of the necrotic and abscessual material may resolve the condition.
... With particular regard to FS, it is challenging to label this manifestation as a complication of OS as "post-operative swelling" when it is a normal bodily response to surgical trauma and is part of the normal healing process. While post-surgical swelling is not a complication per se, it is essential for healthcare professionals to monitor the extent and duration of swelling, as excessive or prolonged swelling may indicate other underlying issues or complications such as an abscess [18]. It is crucial to highlight that none of the studies [10][11][12][13] included in the investigation assessed both post-operative FS and occlusion simultaneously. ...
The purpose of this systematic review was to assess the postoperative facial swelling (FS) and occlusion attained with clear aligner therapy (CAT) and fixed orthodontic therapy (OT) after orthognathic surgery (OS). The focused question was "Is there a difference in postoperative FS and occlusion a ained with CAT and fixed OT after OS?" Indexed databases were searched up to and including October 2023 using different keywords. Original clinical studies that compared postoperative FS and occlusion a ained with CAT and fixed OT after OS were included. Risk of bias (RoB) and quality of evidence were also assessed. Four retrospective studies were included. One study reported no difference in postoperative FS among patients that underwent CAT or fixed OT after OS. In one study, patients treated with CAT demonstrated less FS in the first post-surgical week than individuals that underwent fixed OT. In one study, postoperative occlusion was comparable among patients that underwent CAT or fixed OT, whereas in another, postoperative occlusion was be er in patients that underwent fixed OT than CAT. All studies had a moderate RoB and none of the investigations were based on power-adjusted data. Based upon the sparsity and questionable quality of available evidence, there is a need to render a firm conclusion. However, it seems that CAT and fixed OT are comparable in relation to postoperative occlusion and FS after OS.
... 9 A preceding periradicular infection in the region of mandibular molars has also been reported in a few cases. 10,11 The management of a tongue abscess depends on patient history, clinical features, and investigative procedures such as ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI). 2 A tongue abscess must be distinguished from other tongue swellings, such as cellulitis, lingual tumors, etc. 2,3 The recommended method for management has been incision and drainage along with pus culture collection and using systemic antibiotics. 1,3,7 Its recurrence rate is low, but follow-up is important to ensure a good prognosis. ...
... A tongue abscess on its anterior two thirds is rare. 2 Its occurrence in an eight-year-old boy without any immune deficiency or foreign body entrapment makes this case even more rare. Varghese et al. 11 reported a lingual abscess following tooth extraction and stated that dental infections spreading through lingual cortical bone can constitute an etiology. In the present case, the root tip raised the suspicion of abscess causation. ...
... Tongue abscesses have been shown to resolve after incision/drainage and antibiotic use. 10,11 In the present case, healing occurred uneventfully and no recurrence was observed in follow-ups over two years. ...
The tongue is a muscular organ with a rich blood supply and acts as an immune defence mechanism. The occurrence of a tongue abscess without immune deficiency is rare. The purpose of this report is to present the case of an eight-year-old boy with a spherical, pinkish-yellow, fluctuant, nontender swelling measuring two cm in diameter on the right anterolateral border of the tongue, causing difficulty in swallowing and speaking. Ultrasonography was performed, followed by a 940-nm diode laser-assisted incision and drainage under local anesthesia. Healing was uneventful, with no recurrence for two years now. A tongue abscess can be life-threatening due to its ability to cause respiratory obstruction. The diode laser can be a safe and effective tool for its management. (J Dent Child 2018;85(3):147-50)
Background: Lingual abscess is a rare clinical entity defined as an infectious process within the tongue parenchyma. A lingual abscess may occur in the anterior two thirds or posterior aspect of the tongue. Historically, there are differences in causation, presentation and management between anterior and posterior based abscess. This systematic review aims to critically analyse differences between anterior and posterior lingual abscess.
Methods: A systematic review was conducted using the terms "lingual abscess", and "tongue abscess" across the databases PubMed, SCOPUS, Medline, Embase and Google Scholar. Further articles were identified through citation screening of the selected articles. The authors included articles published from 1970 to 2023, published in English that reported cases of lingual abscess. Risk of bias was assessed using a standardized tool.
Results: A total of 53 studies with 73 cases of lingual abscess were identified. There were 45 (61.6%) anterior, 26 posterior (35.6%) and 2 (2.8%) total aspects of the tongue. Clinical presentation of otalgia (25.9% vs. 2.2%, P=0.002) and sialorrhoea (18.5% vs. 4.3%, P=0.047) was significantly more likely in a posterior located abscess, along with involvement of the epiglottis compared to anterior abscess (18.5% vs. 0.0%, P=0.002). An anterior abscess was significantly more likely to have no radiographic imaging (41.3% vs. 7.4%, P=0.002) or ultrasound (17.4% vs. 0.0%, P=0.022), whereas a posterior abscess was significantly more likely to receive computed tomography scanning (85.2% vs. 34.8%, P<0.001). No significant difference was seen between anterior and posterior lingual abscess in relation to drainage management, isolated pathogens, or antimicrobial prescribing.
Conclusions: A low threshold for imaging should be considered when patients present with signs and symptoms consistent with a posterior lingual abscess. Management principles should involve maintaining airway patency, drainage of the abscess and antimicrobial therapy.
Tongue is an organ, i.e., constantly exposed to microbes and likelihood of trauma, yet does not usually show a predilection for developing an abscess. Cases of acute lingual swelling due to an abscess are unusual; hemorrhage, infarction, edema, and tumor being the commonly responsible etiologies. Herein, we report a case of glossal abscess that was chronic in nature (2 months’ duration), presenting with uncharacteristic symptoms and no remission on taking antibiotics. In the absence of typical signs, Magnetic resonance imaging (MRI) provided an invaluable and accurate diagnosis, which allowed proper treatment to be rendered.
How to cite this article
Mishra I, Karjodkar F, Sansare K, Prakash N, Dora A, Goyal S. Glossal Abscess: An Unusual Presentation. Int J Otorhinolaryngol Clin 2016;8(1):41-44.
