Lingual abscess presenting as airway obstruction in the infant

Recurrent Lingual Abscess in an Elderly Female With Bulbar Amyotrophic Lateral Sclerosis

A lingual abscess is a rare condition that was scarcely described in clinical textbooks. A lingual abscess recurrence is rare and has only been described twice in the literature. Typically, the tongue and oral cavity have multiple intrinsic properties which stave off intralingual infection; however, there may be situations in which these properties are compromised, as demonstrated in oro-motor disability. Lingual abscesses have the potential to develop into catastrophic obstructive airway issues; therefore, early detection and management are paramount. The following is a presentation of an elderly female with Bulbar Amyotrophic Lateral Sclerosis (ALS) treated conservatively for a lingual abscess with recurrence at eleven months post-treatment. Due to her baseline neuromuscular disorder and elevated anesthesia risk, she was treated in the interventional radiology suite with drain placement and Povidone-Iodine sclerotherapy under conscious sedation with excellent results. 

Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications

Pain can be both a cause and a consequence of sleep deficiency. This bidirectional relationship between sleep and pain has important implications for clinical management of patients, but also for chronic pain prevention and public health more broadly. The review that follows will provide an overview of the neurobiological evidence of mechanisms thought to be involved in the modulation of pain by sleep deficiency, including the opioid, monoaminergic, orexinergic, immune, melatonin, and endocannabinoid systems; the hypothalamus-pituitary-adrenal axis; and adenosine and nitric oxide signaling. In addition, it will provide a broad overview of pharmacological and non-pharmacological approaches for the management of chronic pain comorbid with sleep disturbances and for the management of postoperative pain, as well as discuss the effects of sleep-disturbing medications on pain amplification.

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.

The First Patient Report of Tongue Abscess Among Iraqi Population

Tongue abscess is a serious clinical entity which scarcely affects the tongue. It should be treated urgently to prevent airway obstruction or dissemination of infection to a more deep or distant area of the body. This article presented the first clinical report of tongue abscess in Iraq which discussed its clinical presentation, diagnosis, and treatment with a review of literature.

Lingual abscess: a case report

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.

A lingual abscess caused by Streptococcus intermedius

Lingual abscesses are rare. We describe a case in a healthy female with no recent history of trauma. The organism recovered by culture of drainage material collected prior to antibiotic treatment was Streptococcus intermedius, an organism recognized as flora of the oropharynx and associated with abscess formation. The isolate was resistant to clindamycin, which was the antibiotic therapy that the patient received.

Lingual abscess: diagnosis and treatment

BACKGROUND

Lingual abscesses are very rare, and as a result, the individual surgeon usually lacks experience in the diagnosis and therapy of this entity. We present four cases of abscesses of the tongue diagnosed and treated during the past 2 years.

METHODS

The medical records, films, and charts of four patients with lingual abscess were retrospectively reviewed. The clinical presentation, radiographic features, treatment, and outcome of the cases were examined.

RESULTS

Diagnosis was obtained by clinical examination and CT. In all cases, we avoided incision and drainage and preferred draining the abscess and aspirating pus with a large-bore needle through the inferior surface of the tongue. All patients responded remarkably well and did not have any recurrence.

CONCLUSIONS

Lingual abscesses are rare conditions. In contrast to the approach in cases of most deep neck space infections, a more conservative therapeutic approach by needle-aspiration is effective and has the advantages of not exacerbating the edema of the tongue and of avoiding airway compromise.

Recovery of anaerobic bacteria from a glossal abscess in an adolescent

Glossal abscess is infrequent in children. Anaerobic bacteria are rarely recovered from this infection and never have been reported in children or adolescents. A 15-year-old patient presented with a tongue abscess following trauma. Aspirate of the abscess yielded polymicrobial anaerobic flora: Prevotella melaninogenica, Fusobacterium nucleatum, and Peptostreptococcus micros. The patient recovered following incision and drainage and 14 days of antimicrobial therapy with clindamycin. This report illustrates the recovery of anaerobic bacteria from glossal abscess in an adolescent.

Evaluation and management of bilateral vocal cord immobility

Bilateral vocal cord immobility can be life threatening for some patients. Others, who have an open glottic chink, may have a breathy dysphonia, intermittent dyspnea, and stridor. These signs and symptoms may also be found in a number of other conditions that cause weakness or paradoxical motion of the vocal cords that mimics paralysis. These other conditions include central nervous system diseases, neuromuscular disorders, laryngospasm, and psychogenic disorders. In addition, patients with cricoarytenoid joint immobility or interarytenoid scar can also have similar symptoms at presentation. It is critical to consider the differential diagnosis of an assumed bilateral vocal cord paralysis and understand the management of paradoxical movement, weakness, joint fixation, interarytenoid scar, laryngospasm, and psychogenic disorders. The treatment for bilateral immobility should proceed only after a thorough evaluation, which might include electromyography and/or examination during general anesthesia under dense anesthetic paralysis. Reconstructive procedures are the treatments of choice, and destructive procedures should be chosen only as a last resort.

Acute tongue abscess: report of two cases

Tongue abscesses are extremely rare. Two cases caused by periodontal pathogens are presented.

Glossal abscess presenting as unilateral tongue swelling

Glossal abscesses are extremely rare, only 29 cases having been described in the last 28 years. Clinical and ultrasound examination should establish the diagnosis, and treatment should be by surgical incision and drainage. We report a case of glossal abscess presenting as a unilateral swelling of the tongue.

The three bellies of the canine cricothyroid muscle

The cricothyroid muscle is capable of multiple functions, including vocal cord elongation and adduction. In addition, the cricothyroid can lengthen the glottis as well as provide posture to the cricothyroid joint. The purpose of the present study is to demonstrate that the many functional capabilities of the cricothyroid are a reflection of the existence of separate bellies within the muscle. Microdissection revealed three distinct muscle bellies within the cricothyroid: rectus, oblique, and horizontal. These differ in fiber orientation (rectus 79 degrees, oblique 48 degrees, horizontal 7 degrees) and are separated by fascial planes. Histochemistry showed that these three bellies are composed of different percentages of slow twitch fibers (rectus 31.3%, oblique 43.3%, horizontal 39.6%). Finally, electromyography demonstrated differences in the electrical activity patterns of the three bellies. It is concluded that the cricothyroid muscle is composed of three distinct muscle bellies that probably play separate roles in the complex function of this muscle.

Adult and pediatric pharyngitis: a review

Acute pharyngitis is frequently encountered in the ambulatory care setting. Although usually of viral etiology, streptococcal disease is the focus of diagnostic efforts, in light of significant suppurative and nonsuppurative sequelae. The traditional symptoms of fever, adenopathy, and pharyngeal exudate are suggestive, but not diagnostic of streptococcal pharyngitis. Thus, the importance of diagnostic testing, including Group A beta hemolytic strep antigen screen and culture, is emphasized. Recent innovations in therapy include modification of antibiotic dosing regimens and use of cephalosporins to improve patient compliance.