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Plata-Huerta HH, Rosero-Castillo AE, Trevino Gonzalez JL. Lingual Abscess in an Adult Patient With Pierre Robin Sequence: A Case Report. Cureus 2024; 16:e65460. [PMID: 39184796 PMCID: PMC11345102 DOI: 10.7759/cureus.65460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/27/2024] Open
Abstract
A lingual abscess is a rare but serious infection within the tongue parenchyma, posing significant risks due to potential airway obstruction. Despite advancements in oral hygiene and antibiotics, timely diagnosis and treatment are critical to prevent severe complications. In this case, we report a 29-year-old male with Pierre Robin sequence (PRS) who presented with a four-day history of severe tongue pain, swelling, decreased appetite, and fever, without any reported trauma. Examination revealed left-sided tongue swelling, poor oral hygiene, and notable Mallampati III classification. A neck CT scan confirmed an abscess in the left hemitongue involving the intrinsic and mylohyoid muscles, measuring 26.5 x 30 x 30.5 mm with a volume of approximately 8 cc. Prompt intravenous antibiotic treatment was initiated, leading to spontaneous abscess drainage and significant clinical improvement. The patient was discharged after five days of intravenous antibiotics and continued oral antibiotics. At one-week follow-up, he was asymptomatic and fully recovered. This case underscores the importance of recognizing the potentially life-threatening nature of lingual abscesses, particularly in syndromic patients like those with PRS, who may experience quicker airway obstruction due to craniofacial abnormalities, such as micrognathia and glossoptosis. Given the rarity of such conditions, awareness and readiness to address these emergencies are essential for ensuring patient safety and positive outcomes.
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Affiliation(s)
- Hiram H Plata-Huerta
- Otolaryngology - Head and Neck Surgery, Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, MEX
| | - Astrid E Rosero-Castillo
- Otolaryngology - Head and Neck Surgery, Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, MEX
| | - Jose Luis Trevino Gonzalez
- Otolaryngology - Head and Neck Surgery, Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, MEX
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Safia A, Shehadeh R, Merchavy S. Anterolateral Lingual Abscess in a Young Adult: A Comprehensive Case Study. EAR, NOSE & THROAT JOURNAL 2024:1455613241233922. [PMID: 38369962 DOI: 10.1177/01455613241233922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Lingual abscesses, characterized by infectious collections of pus within the tongue parenchyma, are rare and poorly understood clinical entities. Despite their potential for severe complications, literature on lingual abscesses remains limited, consisting mainly of sporadic case reports. This comprehensive case study examines the challenges and successful management of a severe anterolateral tongue abscess in a young adult, contributing to the emerging body of knowledge on this condition. A young adult male presented with a progressively worsening painful, swollen tongue and dyspnea over 2 days. Urgent intervention was necessary to prevent potential airway compromise despite maintaining normal oxygen saturation. The patient's medical history showed no prior oral infections, illnesses, or relevant medical conditions. Detailed clinical assessment, utilization of imaging modalities such as contrast-enhanced computed tomography scan and ultrasonography, and collaboration with a maxillofacial surgeon guided accurate diagnosis and successful treatment. This case study provides valuable insights into the diagnosis and management of anterolateral lingual abscess in a young adult. It underscores the importance of heightened clinical awareness, precise diagnostic techniques, and multidisciplinary collaboration for optimal patient outcomes. The report contributes to the limited literature and emphasizes the need for further research to establish evidence-based guidelines for lingual abscess management.
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Affiliation(s)
- Alaa Safia
- Department of Otolaryngology-Head and Neck Surgery Unit, Rebecca Ziv Medical Center, Safed, Israel
| | - Rabie Shehadeh
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Shlomo Merchavy
- Department of Otolaryngology-Head and Neck Surgery Unit, Rebecca Ziv Medical Center, Safed, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Rampi A, Tettamanti A, Bertotto I, Comini LV, Howardson BO, Luparello P, Di Santo D, Bondi S. Atypical Tongue Abscesses Mimicking Submucosal Malignancies: A Review of the Literature Focusing on Diagnostic Challenges. Cancers (Basel) 2023; 15:5871. [PMID: 38136415 PMCID: PMC10741429 DOI: 10.3390/cancers15245871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
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.
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Affiliation(s)
- Andrea Rampi
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.R.); (A.T.); (B.O.H.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alberto Tettamanti
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.R.); (A.T.); (B.O.H.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Ilaria Bertotto
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy;
| | - Lara Valentina Comini
- Otorhinolaryngology Unit, Head and Neck Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (L.V.C.); (P.L.); (D.D.S.)
| | - Bright Oworae Howardson
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.R.); (A.T.); (B.O.H.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Paolo Luparello
- Otorhinolaryngology Unit, Head and Neck Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (L.V.C.); (P.L.); (D.D.S.)
| | - Davide Di Santo
- Otorhinolaryngology Unit, Head and Neck Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (L.V.C.); (P.L.); (D.D.S.)
| | - Stefano Bondi
- Otorhinolaryngology Unit, Head and Neck Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (L.V.C.); (P.L.); (D.D.S.)
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4
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Lingual abscess: A case report of a rare clinical entity. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Challenges in the Diagnosis of a Posterior Lingual Abscess, a Potential Lethal Disorder. ACTA ACUST UNITED AC 2019; 41:64-66. [DOI: 10.1097/paf.0000000000000514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lingual Abscess: Predisposing Factors, Pathophysiology, Clinical Manifestations, Diagnosis, and Management. Int J Otolaryngol 2018; 2018:4504270. [PMID: 30524479 PMCID: PMC6247437 DOI: 10.1155/2018/4504270] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/15/2018] [Indexed: 12/04/2022] Open
Abstract
Lingual abscess is a rare disorder, and current knowledge regarding clinical manifestations and treatment modalities has not been well established. This study presented 6 cases of lingual abscess patients between January 2012 and December 2017. There were three men and three women. Median age was 54 years. Odynophagia and local pain were the common presenting symptoms. Local trauma was the main predisposing factor of anterior abscess, while lingual tonsillitis or infected thyroglossal cyst was the predisposing factor of posterior abscess. An impending airway obstruction was identified in two patients, requiring tracheostomy. All patients achieved an excellent outcome with a combination of surgical drainage and proper antibiotics as well as using proper investigation for detecting unusual areas of lingual abscess. According to the data from the study's results and review of the relevant literature, an abscess located at the anterior two-thirds of the tongue is easy to diagnose while the posterior one-third of the tongue abscess is relative difficulty. Using contrast-enhanced computed tomography increases diagnostic accuracy, especially on the tongue base and deep space infection. The management strategies include (1) protecting the airway, (2) draining the abscess by needle aspiration or surgery, and (3) administering antibiotics early. Our series showed a superiority of surgical drainage when the patients present with marked tissue edema, deep loculated infection, and airway obstruction.
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Binar M, Arslan F, Aydin U. Another cause of difficult airway in an elderly patient: Tongue-base abscess. Gerodontology 2018; 35:155-158. [PMID: 29733530 DOI: 10.1111/ger.12330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE An abscess of the tongue base is rare, but it can be a potentially life-threatening situation in elderly patients. CASE REPORT A 72-year-old male patient presented with mid-anterior neck swelling, odynophagia, poor oral hygiene and severe dyspnoea. After a difficult intubation, the muscles were dissected via a submental suprahyoid approach and the abscess was drained. CONCLUSION Poor oral hygiene may predispose elderly patients to tongue-base abscesses. An early decision should be made for surgical drainage due to the risk of airway obstruction.
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Affiliation(s)
- Murat Binar
- Department of Otolaryngology, Head and Neck Surgery, Gulhane Medical School, Ankara, Turkey
| | - Fatih Arslan
- Department of Otolaryngology, Head and Neck Surgery, Beytepe Murat Erdi Eker State Hospital, Ankara, Turkey
| | - Umit Aydin
- Department of Otolaryngology, Head and Neck Surgery, Gulhane Medical School, Ankara, Turkey
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Nurdoğan A. A tongue mass. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:75-76. [DOI: 10.1016/j.anorl.2017.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 10/18/2022]
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Abstract
Background Lingual abscesses have become extremely rare since the discovery of antibiotics, despite the relatively frequent exposure of tongue to bite trauma during mastication and seizures. It is a potentially life-threatening clinical entity. Even though there were some case reports on tongue abscess from overseas, none of them were reported from Africa, particularly from Ethiopia. Case presentation A 36-year-old male patient with severe, continuous pain and swelling of tongue for 6 weeks was presented to Goba Referral Hospital. The swelling was 2 cm by 1 cm, located on posterior central tongue, and frank pus oozed from the center of the swelling. He had associated dysphagia, odynophagia, and speech difficulty. He had no previous personal and family history of similar illness and tonsillitis. Gram staining revealed the presence of Gram-positive cocci in clusters. Pyogenic lingual abscess was the diagnosis. Treatment included incision and drainage with the administration of systemic antibiotics, which covered both aerobic and anaerobic organisms, and anti-pain drugs. The condition did not relapse in 6 months of follow-up. Conclusion Lingual abscess should be considered in patients presenting with tongue swelling, dysphagia, odynophagia, and speech difficulty. Since lingual abscess that occurs on the posterior part of the tongue has diagnostic difficulty, professionals in rural setup where diagnostic resources (such as ultrasound and magnetic resonance imaging) are scarce should be careful not to misdiagnose it. Incision and drainage with the administration of systemic antibiotics and anti-pain drugs is an effective treatment option for lingual abscess.
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Affiliation(s)
- Kebebe Bekele
- Department of Surgery, School of Medicine, Madda Walabu University, Bale Goba
| | - Desalegn Markos
- Department of Neonatology Nursing, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Abstract
We report the case of a 14-month-old boy who developed a swelling of the tongue with fever, dyspnea during sleep and dysphagia. An anterior lingual abscess was identified by magnetic resonance imaging. He developed 4 recurrent lingual abscesses thereafter. Pediatricians should be aware of this problem because it can be a life-threatening condition.
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11
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Man With Throat Pain. Ann Emerg Med 2017; 69:514-528. [DOI: 10.1016/j.annemergmed.2016.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Indexed: 11/17/2022]
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12
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Lefler JE, Masullo LN. Lingual Abscess in the Setting of Recent Periodontal Antibiotic Injections. J Emerg Med 2016; 51:454-456. [DOI: 10.1016/j.jemermed.2016.05.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
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A rare cause of acute Dysphagia: abscess of the base of the tongue. Case Rep Gastrointest Med 2015; 2015:431738. [PMID: 25802771 PMCID: PMC4352731 DOI: 10.1155/2015/431738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 11/17/2022] Open
Abstract
Dysphagia represents a difficulty in passage of solid or liquid foods from the oral cavity into the stomach and is considered as an alarm symptom of gastrointestinal system. It often indicates an organic disease and needs to be explained. In this paper, a case of 61-year-old man with posterior tongue abscess is presented.
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Spontaneous lingual abscess in an immunocompromised patient. Am J Emerg Med 2013; 32:492.e1-2. [PMID: 24332904 DOI: 10.1016/j.ajem.2013.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 11/14/2013] [Indexed: 11/22/2022] Open
Abstract
Acute lingual abscess is a rare yet life-threatening clinical entity. Lingual abscess must be appropriately diagnosed and treated in the emergency department to avoid acute airway compromise. A 68-year-old woman on immunomodulatory medication for rheumatoid arthritis presented to the emergency department with left facial pain and swelling. An anterior lingual abscess was diagnosed on computed tomographic scan. The most common cause of lingual abscess is direct trauma, although immunocompromised state is a predisposing risk factor. Intravenous antibiotics are the primary treatment modality, with consideration given to adjunctive surgical drainage. We present this case to increase awareness surrounding this diagnosis among emergency physicians. Spontaneous lingual abscess should be considered in immunocompromised patients who present to the emergency department with tongue pain and edema even in the absence of lingual trauma.
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Kulkarni CD, Verma AK, Kanaujia R. A rare case of hemilingual abscess in a 17-year-old girl: the ease of ultrasound and the advantage of MRI. Jpn J Radiol 2013; 31:491-5. [PMID: 23504397 DOI: 10.1007/s11604-013-0198-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/26/2013] [Indexed: 11/24/2022]
Abstract
Abscess of the tongue is rare owing to the rich vascularity and muscularity of the tongue and anti-infective properties of saliva. An abscess limited only to one half of the tongue is even more rare. We report a case of hemilingual abscess in a 17-year-old girl who presented with high-grade fever and a swollen and immobile tongue. Ultrasound (US) through floor of mouth showed inflammatory changes and collection within the right half of the genioglossus muscle. Magnetic resonance imaging (MRI) confirmed this finding, and isolated right-sided involvement was identified. US-guided aspiration of the collection yielded pus that showed gram-positive cocci on microscopy. The patient was managed conservatively, and repeat US showed resolution of the abscess. The importance of US as a quick, inexpensive, and versatile imaging technique and the precision of MRI regarding the extent of abscess of tongue are stressed.
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Affiliation(s)
- Chaitanya D Kulkarni
- Department of Radiodiagnosis, Ganesh Shankar Vidhyarthi Memorial Medical College-LLR Hospitals, Swaroop Nagar, Kanpur, 208002, Uttar Pradesh, India.
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Kikidis D, Marinakis K, Sengas J, Chrysovergis A. Lingual abscess in a psychiatric patient: a case report. Case Rep Med 2012; 2012:194292. [PMID: 22291713 PMCID: PMC3265052 DOI: 10.1155/2012/194292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 10/12/2011] [Accepted: 10/12/2011] [Indexed: 11/17/2022] Open
Abstract
We present a 46-year-old psychiatric patient presenting with a lingual abscess. This paper covers the epidemiology, clinical features, diagnosis, and differential diagnosis with a view to assisting emergency physicians in the timely recognition and management of this rare but potentially life-threatening condition.
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Affiliation(s)
- D. Kikidis
- ENT Department, University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - K. Marinakis
- ENT Department, University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - J. Sengas
- ENT Department, University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - A. Chrysovergis
- ENT Department, University of Athens, Hippokration Hospital, 11527 Athens, Greece
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