Lingual haematoma leading to upper airway obstruction

Self-Induced Traumatic Macroglossia: Case Report and Literature Review

Traumatic macroglossia is an extremely rare condition characterized by a sudden edematous swelling of the tongue due to trauma. We report a rare case of traumatic macroglossia in a 37-year-old male with known trisomy 21 and epilepsy who presented to the emergency room with a huge protruded tongue due to aggressive behavior and a history of multiple tongue tractions, leading to sudden severe tongue swelling without any respiratory distress symptoms. The examination was unremarkable; fixable nasolaryngoscopy relieved bilateral vocal cord movement, and there was no laryngeal edema. The patient was managed immediately by endotracheal intubation to secure the airway, and corticosteroids were used to diminish and stop the tongue swelling. We describe the clinical management for such patients, highlighting the different causes of traumatic macroglossia. A few cases have been reported in the literature, but this is the first case to report self-induced traumatic macroglossia in a seizure-free patient managed successfully by endotracheal intubation, corticosteroids, a bite block, and warm wet dressing.

A Novel Approach for the Management and Prevention of Self-Induced Masticatory Lingual Trauma in the Neurologically Injured Patient

Self-induced masticatory trauma is an unfortunate complication of a variety of neurologic disorders, including epileptic seizures, cerebral palsy, mental retardation, psychiatric disease, and brain trauma, in addition to other described etiologies. While single or occasional occurrences of tongue biting are relatively benign, recurrent self-injury can pose major issues and predispose a patient to chronic, severe complications. To prevent the complications associated with ongoing trauma to the tongue, steps must be taken to protect individuals from chronic self-injurious behavior. Often, these interventions cause significant morbidity to the patient, such as elective removal of the dentition or complications in gaining access to the oral cavity/airway associated with maxillomandibular fixation. In the neurologically impaired patient, immobilization of the jaws is frequently associated with higher rates of agitation, aspiration, or development of complicating infections of the gingival tissues. We report a case of self-induced masticatory trauma managed with the fabrication of a custom-fabricated oral appliance. This treatment modality successfully prevents the recurrence or incidence of self-induced masticatory trauma to the tongue. The benefits of this modality are that it allows access to the oral cavity, prevents immobilization of the jaws, has minimal to no morbidity, and is completely reversible.

Spontaneous sublingual space hematoma secondary to hypertension: A case report and review of literature

Sublingual hematoma is a rare complication of oral anticoagulant use. Spontaneous sublingual hematoma secondary to hypertension is even rarer and their management remains enigmatic. We present such a case that we successfully managed conservatively along with a review of relevant literatures.

Spontaneous lingual and sublingual haematoma: a rare complication of warfarin use

Warfarin is commonly used for prevention of embolic events. Bleeding is the main side effect of warfarin. Lingual and sublingual haematoma are rare. In the literature, nine cases have so far been reported. We report the case of a 70-year-old Caucasian woman who developed spontaneous lingual and sublingual haematomas while on warfarin therapy. Spontaneous lingual and sublingual haematoma are rare, but can be potentially life-threatening complications as they cause airway obstruction. To the best of our knowledge, this is the first reported case of earliest haematoma after warfarin use.

Life-threatening expansive sublingual hematoma: a stab wound with lingual artery injury

Vascular injuries are a constant risk in facial trauma, although bone and soft tissues of the face have provided some protection to the larger blood vessels. However, penetrating injuries usually do not have this type of protection and can damage significant vascular arteries. This article presents a case of a stab wound, which led to airway obstruction arising to a large sublingual hematoma due to lingual artery injury. A healthy 44-year-old man was stabbed in the submandibular region and admitted with an airway obstruction. He was subjected to an emergency tracheotomy and evolved with progressive sublingual edema. Computed tomography (CT) angiography showed a left lingual artery injury with the formation of an expansive hematoma. The CT angiography findings helped to identify the cause of the hematoma and guided the surgery to drain the hematoma after ligation of the lingual artery. The treatment was safely performed as planned and evolved uneventfully. The patient recovered fast and well and presented normal functions 6 months after the treatment. This surgical technique is an effective method for treating such injuries because it can be safely performed when guided by CT angiography. The authors argue that the demand for vascular lesions should be routine in patients who have facial trauma.

A tricky tracheotomy: airway management dilemma following unusual stab injury to the mouth

Traumatic wounding to the upper aerodigestive tract can cause acute airway compromise. In these circumstances establishment of a safe airway is vital. We present a case report illustrating the decision making pathway in such a difficult case.

Lingual Hematoma and Heparin-induced Thrombocytopenia: A Case Report

Lingual hematoma is a rare but potentially fatal cause of upper airway obstruction. Patients receiving anticoagulants such as heparin can suffer from significant complications of these medications. Not only does heparin exert effects directly on the coagulation cascade, but it has the potential to cause thrombocytopenia by stimulating formation of antibodies against platelets. We present the case of a patient being treated with heparin for a deep-vein thrombosis, who subsequently developed heparin-induced thrombocytopenia and lingual hematoma, necessitating tracheotomy.

Lingual hematoma threatening airway obstruction in a patient on oral anticoagulation with warfarin

Warfarin sodium is a commonly used oral anticoagulant agent. It has been well documented that, when effective anticoagulant therapy is employed in treating thromboembolic disease, hemorrhage is a possible complication that can be spontaneous without a history of trauma. The numerous sites of bleeding are the genitourinary and gastrointestinal tracts, the central nervous system, the nose (epistaxis), the penis (priapism), the retroperitoneum, wounds (surgical or traumatic), and subcutaneous tissues during warfarin therapy, but the hemorrhage rarely causes bleeding compromising a patient's airway. We report a case of a spontaneous lingual hematoma that developed during oral anticoagulation therapy. This life-threatening complication of warfarin therapy and its successful management without surgery indicates that observation, close monitoring and reversal of anticoagulation can be a reasonable management option.

Spontaneous Sublingual Hematoma as a Complication of Severe Hypertension: First Report of a Case

We describe what we believe is the first reported case of a sublingual hematoma secondary to severe hypertension. The patient, a 77-year-old woman, experienced a spontaneous hematoma of the floor of the mouth, tongue, and sublingual space that eventually caused an airway obstruction. We performed an emergency tracheostomy under local anesthesia and then evacuated the hematoma through an incision along the floor of the mouth. The patient recovered uneventfully.

Massive postoperative swelling of the tongue: manual decompression and tactile intubation as a life-saving measure

Massive swelling of the tongue due to haemorrhage is a rare but potentially fatal complication secondary to trauma, surgery, tumour invasion or uncontrolled anticoagulant therapy. This article presents a report of bleeding from the left lingual artery secondary to elective excision of a lipoma of the floor of the mouth and subsequent life-threatening upper airway obstruction. In this case, the upper airway obstruction was managed by manual decompression of the tongue and tactile nasal intubation. To our knowledge this case provides the first description of using this method in life-threatening upper airway obstruction caused by massive haemorrhagic swelling of the tongue.

Traumatic macroglossia: a life-threatening complication

OBJECTIVE

To describe the use of muscle relaxants and a bite raiser to avoid continued tongue trauma.

DESIGN

Case report.

SETTING

A tertiary general intensive care unit (ICU).

INTERVENTIONS

Muscle relaxation and bite raiser.

MAIN RESULTS

Muscle relaxation and a bite raiser were used in a 17-yr-old male with traumatic macroglossia, which allowed for rapid resolution of edema and prevented additional trauma to the tongue.

CONCLUSION

Early use of a bite raiser together with muscle relaxants allows for more rapid solution of edema and prevention of additional trauma to the tongue in patients with traumatic macroglossia.

Acute enlargement of the tongue

Acute enlargement of the tongue can present as an emergency. The problems of management in the acute situation and the diagnosis of the underlying condition are discussed and illustrated with reference to four unusual cases. There is a case for a simple classification and such a classification is presented.

Lingual artery hematoma resulting in upper airway obstruction

A case of upper airway obstruction from a lingual artery hematoma after suturing of a puncture wound to the tongue is reported. The anatomy of the tongue and upper airway is reviewed to better understand the mechanism of obstruction. The emergency physician should be aware of this rare and potentially lethal complication to what might initially seem to be a trivial injury.

Tissue plasminogen activator-associated lingual artery hemorrhage

Reported is the case of a patient with vertebrobasilar artery ischemia who received tissue plasminogen activator with resulting hemorrhage into the tongue and nearly exsanguinating hemorrhage from a branch of the lingual artery. Suggestions for immediate management of the hemorrhage as well as prevention are presented. As the use of thrombolytic agents increases and the list of their indications expands, unusual life-threatening hemorrhagic problems other than gastrointestinal or intracranial bleeding will be seen, and management decisions may be life saving.

Lingual cellulitis causing upper airway obstruction

A case is reported in which upper airway obstruction occurred in an immunosuppressed patient due to the presence of lingual cellulitis.