Lingual thyroid--a threat to the airway

The occurrence of a thyroid gland superficially placed on the pharyngeal portion of the tongue is rare, but poses problems to the patient and anaesthetist. This report describes a patient with a lingual thyroid and a history of problems associated with it that resulted in admission to the ICU and warnings about future intubation of the larynx. The patient underwent awake tracheal intubation using a standard fibreoptic assisted technique, and was advised that she purchase an appropriate Medic-Alert bracelet.

Ankyloglossia and its influence on maxillary and mandibular development. (A seven year follow-up case report)

The consequences of not treating improper tongue function may be very important as this organ can influence face development and dental therapy. The role of the tongue in the development of the skeletal structures of the face has been considered in different perspectives over the years. For some, the tongue adapts to the "tongue box," for others the "tongue box" has been created and stabilized by the morphogenetic action of the tongue during development and growth. A case of ankyloglossia treated with lingual frenectomy and followed clinically and radiologically for seven years is reported. Spontaneous upper arch expansion occurred and therefore orthodontic treatment following surgical intervention was unnecessary.

Breath-holding-like spells in an infant: an unusual presentation of lingual thyroglossal duct cyst

The authors report the case of an infant with a lingual thyroglossal duct cyst who presented with breath-holding-like spells, which actually represented life-threatening ball-valve obstruction of the larynx, leading to hypoxemia and transient cerebral dysfunction. When evaluating apparent breath-holding spells in young infants, physicians should include dynamic, episodic upper airway obstruction in the differential diagnosis.

Ankyloglossia: controversies in management

PURPOSE

To determine current beliefs regarding ankyloglossia and its treatment.

DESIGN

Anonymous written survey.

PARTICIPANTS

Otolaryngologists (OTO, n=423), pediatricians (PD, n=425), speech pathologists (SP, n=400), and lactation consultants (LC, n=350) were randomly selected from professional membership lists, with a response rate of 209 (49%), 235 (55%), 150 (37.5%), and 203 (58%), respectively.

CLINICAL FINDINGS

Sixty-nine percent of LCs, but a minority of physician respondents, believe tongue-tie is frequently associated with feeding problems. Sixty percent of OTOs, 50% of SPs, but only 23% of PDs believe tongue-tie is at least sometimes associated with speech difficulties. Sixty-seven percent of OTOs versus 21% of PDs believe tongue-tie is at least sometimes associated with social/mechanical issues. Surgery is recommended at least sometimes for feeding, speech, and social/mechanical issues by 53, 74, and 69% of OTOs, respectively, but by only 21%, 29%, and 19% of PDs.

CONCLUSION

The significance of ankyloglossia in children remains controversial, both within, and between, specialty groups.

Sublingual gastric duplication cyst causing respiratory obstruction: case report

A four-month old girl presented with difficulty in feeding and respiratory obstructrion from a sublingual cyst. Respiratory obstruction was relieved by needle aspiration of the cyst, followed 14 days later by complete excision. Histology of the cyst wall confirmed it to be a gastric duplication cyst. Though the gastric mucosa has a high propensity to deviate to ectopic sites, sublingual location is uncommon. The treatment of such cysts is preferably complete excision. However, when the cyst wall is closely associated with vital structures, cyst mucosectomy or partial excision with stripping of the mucosa of the residual part may suffice.

Paraneoplastic pemphigus associated with Castleman's tumour

We present a case of paraneoplastic pemphigus associated with Castleman's disease. Our patient had stomatitis and vulvar erosions followed by a cutaneous polymorphous eruption. Investigations for neoplasia disclosed a Castleman's tumour suggesting the diagnosis of paraneoplastic pemphigus. The diagnosis was supported by immunoblotting using an extract of cow tongue although keratinocytes extracts did not identify relevant target antigens. One year after surgical excision of the tumour the patient remained unwell with persistent buccal erosions and lymphopenia. This case is unusual because of the length of its evolution before the discovery of the Castleman's tumour. It is only the second occasion that the association between paraneoplastic pemphigus and Castleman's tumour has been reported. Our case emphasizes the usefulness of immunoblotting on cow tongue in suspected cases of paraneoplastic pemphigus.

Familial occurrence of congenital hypothyroidism due to lingual thyroid gland

Two sisters who presented with midline neck masses proved to be biochemically hypothyroid. Thyroid scintigraphy supplemented with perchlorate discharge testing showed lingual thyroid glands and ruled out the expected autosomal recessive organification defect. The related literature is reviewed.

Preliminary investigation of the association of oral lichen planus and hepatitis C

OBJECTIVE

The aim of this investigation was to determine if an association exists between hepatitis C virus and oral lichen planus.

STUDY DESIGN

Three groups of subjects were selected: 505 patients with hepatitis C virus infection (group 1), 100 patients with oral lichen planus (group 2), and a randomly selected control group (age- and gender-matched) of 100 healthy subjects (group 3). The prevalence of oral lichen planus was determined in groups 1 and 3, and the prevalence of hepatitis C virus infection was established in groups 2 and 3.

RESULTS

The prevalence of oral lichen planus was 3.36% (n = 17) in group 1 and 1% (n = 1) in the control group; the prevalence of hepatitis C virus infection was 23% (n = 23) in group 2, and 5% (n = 5) in the control group. No significant differences were observed in the incidence of oral lichen planus in group 1 between those patients who received interferon and those who did not. The 17 patients in group 1 who manifested oral lichen planus and hepatitis C virus infection simultaneously exhibited a marked tendency to have only reticular lesions (70.6%), with involvement of the buccal mucosa in 88.2% of these patients, the tongue in 29.4%, and the gingiva in 11.8%. Analyzing a randomized subgroup of 143 patients from group 1 (subgroup 1) that was matched by age and gender with groups 2 and 3, we found that the incidence of oral lichen planus in patients with hepatitis C virus infection (subgroup 1) was greater than in the control group (5.59% vs 1%), though this was not statistically significant (chi2 = 0.119; p = 0.06). In contrast, group 2 exhibited a statistically significant higher incidence of hepatitis C virus infection (23%) than the controls (5%; chi2 = 0.259, p = 0.0002).

CONCLUSIONS

The prevalence of hepatitis C virus infection in patients with oral lichen planus was greater than in the control series. In our opinion this observation warrants the investigation of potential concomitant hepatitis C virus infection in patients with oral lichen planus.

Primary lingual abscess presenting as acute swelling of the tongue obstructing the upper airway: diagnosis with MR

We report the sudden development of an inflammatory process thought to be of the floor of the mouth with subsequent involvement of the respiratory airway. MR imaging showed an enhancing posterior lingual lesion, consistent with an abscess. Immediate surgical drainage relieved the symptoms. MR imaging allowed accurate diagnosis, which was essential for surgical planning in a condition that was otherwise difficult to diagnose.

[Obstructive sleep apnea in children with cerebral palsy]

To determine the etiology of obstructive sleep apnea (OSA) in children with cerebral palsy (CP), a survey using a questionnaire was conducted on parents of 233 CP children (1-5 years old, mean age: 2.7) and on those of 343 control children during a routine medical check-up at the age of three. The prevalence of habitual snoring and nasal obstruction was 63 and 20% in CP children, which were significantly higher than in control children. Sleep apnea episodes and stridor were noted in 19.7 and 15.4% of CP children. A screening sleep study was performed using Apnomonitor II and a pulseoximeter (Pulsox 5) in 48 CP children whose questionnaires revealed habitual snoring and sleep apnea, and it was found that 27 and 58% of the children had on apnea-hypopnea index (AHI) of greater than 5 and a low level of SaO2 (LSaO2) of less than 85%, respectively. When another 10 CP children visited our hospital for treatment of severe OSA, precise evaluations including pharyngeal pressure and fiberscopic examination during sleep as well as a sleep study using an inductive prezysmograph (Respigraph) were performed. Adenoid and/or tonsillar hypertrophy were noted in only 4 children, and the main cause of sleep apnea in the other 6 children was pharyngeal collapse at the lingual base. Their OSA was successfully treated by adenotonsillectomy in 2 children, adenotomy in 2 children, UPPP and lingualplasty in 1 child, tracheostomy in 2 children, and nasal CPAP in 1 child. Before treatment of OSA in CP children, precise evaluation is recommended in order to perform appropriate treatment.

Lingual haematoma: yet another unusual cause of upper airway obstruction

An episode of acute upper airway obstruction was caused by a lingual haematoma, when a patient with end stage renal failure suffered a hypocalcaemic fit and bit his tongue. The large haematoma and profuse bleeding caused the patient to obstruct and become hypoxic, and rendered laryngoscopy and intubation impossible, requiring an urgent tracheostomy to secure the airway.

Combined bilateral submandibular and sublingual swelling, macroglossus, and carpal tunnel syndrome caused by light chain amyloidosis

Three cases of light chain kappa amyloidosis in multiple myeloma patients are described with remarkable involvement of the tongue and swelling of the sublingual and submandibular regions, and without signs of nephropathy despite Bence Jones kappa proteinuria. All three patients had carpal tunnel syndrome at the beginning of their disease course and only moderate gastrointestinal involvement. Primarily for prognostic reasons, amyloidosis should be suspected in such cases, even in the presence of these highly unusual manifestations, and the diagnosis should be confirmed by unambigously-positive biopsies.

Localized amyloid tumor of the tongue. A case report and review of the literature

Amyloid is usually deposited in the tongue, as a part of generalized amyloidosis. Isolated localized amyloidosis of the tongue is relatively rare. We report such a case which presented with glossodynia and glossopyrosis and was thought clinically to represent median rhomboid glossitis. Histologically the amyloid stained positively with Congo-red giving green birefringence under polarized light, was not abolished after permanganate pretreatment and did not react immunohistochemically for amyloid A, beta 2 microglobulin and transthyretin.

Lingual cyst in infancy: importance of palpation for diagnosis

Two infants, 5 and 12 weeks of age, with lingual cysts were presented. Histological findings were compatible with a salivary retention cyst in one and a thyroglossal duct cyst in the other. Both infants were admitted to our hospital because of severe stridor that had developed from one to two weeks of age. Their lingual cysts were easily recognizable by simple palpation and were confirmed by non-invasive imaging techniques, such as ultrasound sonography, computed tomography and magnetic resonance imaging. Lingual cyst in infancy may be large enough to cause stridor and dyspnea, and occasionally result in sudden infant death, although once diagnosis is made a radical operation can be easily performed. Therefore, it is important that palpation in the oral cavity should be performed with all infants with persistent stridor as a part of a physical examination.

Bronchoesophageal fistula secondary to aspiration of tongue adhesion button in a child with glossoptosis

A newborn boy with obstructive apnea secondary to glossoptosis was treated by securing his tongue to his lower lip. Soon after, the button that served for posterior fixation became detached and was thought to have been evacuated via the digestive tract. Twenty-two months later the infant presented with pneumonia involving the right lower lobe and hemoptysis, causing an acute respiratory distress syndrome (ARDS). After mechanical ventilation was started marked gastric distention was observed. Esophagography and bronchography revealed a fistula between the right main stem bronchus and the esophagus. During surgical repair the plastic fixation button was found in the bronchial orifice of the fistula. Despite surgical correction of the fistula the child died of refractory respiratory failure.

Primary localized nodular tongue amyloidosis associated with Sjögren's syndrome

We describe a case of primary localized nodular tongue amyloidosis associated with Sjögren's syndrome in a 62-year-old woman. The presence of Sjögren's syndrome was confirmed both serologically and histologically. The amyloid tumor, which was marginally excised, recurred 3 years later and was re-excised. Immunohistochemical examination revealed that the amyloid protein was of the AL (lambda-light chain) type. Infiltration of plasma cells was observed around the minor salivary glands of the tongue surrounded by amyloid. The relationship between the plasma cells and amyloid deposition is discussed.

Neonatal sublingual traumatic ulceration (Riga-Fede disease): reports of cases

Neonatal sublingual traumatic ulcerations (Riga-Fede disease) can present as mild to severe ulcerations. The associated pain can interfere with infant nursing and nutrition. The preferred, conservative treatment consists of smoothing rough incisal edges, or placing round smooth composites over the incisal edges. Acute ulcerations, and a need for definite, rapid healing, may require extraction of the neonatal teeth.