Lingual abscess mimicking epiglottitis

Lingual Abscess: Predisposing Factors, Pathophysiology, Clinical Manifestations, Diagnosis, and Management

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.

A rare cause of acute Dysphagia: abscess of the base of the tongue

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.

Spontaneous lingual abscess in an immunocompromised patient

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.

Acute abscess of the base of the tongue: a rare but important emergency

BACKGROUND

Acute posterior lingual abscess is rare, but may potentially compromise the airway acutely.

OBJECTIVE

Lingual abscesses call for prompt and aggressive management because they are potentially life-threatening infections. Anterior lingual abscess (the most common) and posterior third lingual abscess must be differentiated.

CASE REPORT

A young man who experienced the beginnings of dyspnea and total aphagia presented to the Emergency Department. A posterior lingual abscess was identified on computed tomography scan.

DISCUSSION

Multi-antimicrobial therapy is the cornerstone of treatment. Surgical drainage is also of critical importance for preventing deeper spread of the infection.

CONCLUSION

We present this case to increase awareness among emergency physicians and head and neck surgeons of the clinical findings of acute abscess of the base of the tongue, which can be difficult to diagnose clinically. Imaging of the oral cavity and pharynx is the key to the diagnosis, and the key to choosing the best surgical strategy.