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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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Mesfin T, Debele G, Seyoum K, Dadi S, Tsegaye M, Gomora D, Kene C, Tolosa G. Tongue Abscess: A Case Report. Int Med Case Rep J 2022; 15:769-772. [PMID: 36605725 PMCID: PMC9809373 DOI: 10.2147/imcrj.s399020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction Abscess of the tongue is a very rare disease that potentially compromises the airway. Acute tongue abscess symptoms include swelling or a lump in the deep tissues of the tongue, throbbing local pain, a discomfort that radiates to the ears, fever, difficulty swallowing, deliberate fixation of the tongue due to pain, and eventually, difficulties breathing. Case This is a 50-year-old male patient who presented with a complaint of severe tongue pain and swelling of three days duration. Associated with this, he had pain while swallowing, difficulty opening his mouth, shortness of breath, and drooling saliva. Likewise, he had a high-grade fever and a global type of headache. On physical examination, there was significant tongue swelling on the left anterolateral area, fluctuant on palpation, and had erythematous border. After informed consent was taken the patient was transferred to the operation room with the diagnosis of tongue abscess. Subsequently, incision and drainage were done under general anesthesia, and about 30mL of thick pus was drained. The pocket was washed with normal saline and 2% hydrogen peroxide. The patient was transferred to the surgical ward with stable vital signs and had been on antibiotics. He was discharged after two days of hospital stay. Conclusion Abscesses in the tongue are quite uncommon due to its rich vascular supply, lymphatic drainage, and saliva's immunologic advantage. Thorough diagnosis and successful treatment of tongue abscess prevent potential airway compromise. Antibiotic treatment should cover gram-positive and gram-negative anaerobes.
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Affiliation(s)
- Telila Mesfin
- Department of Medicine, Madda Walabu University Goba General Hospital, Goba, Ethiopia,Correspondence: Telila Mesfin, Tel +251931504321, Email
| | - Gosaye Debele
- Department of Surgery, Madda Walabu University Goba General Hospital, Goba, Ethiopia
| | - Kenbon Seyoum
- Department of Midwifery, Madda Walabu University Goba General Hospital, Goba, Ethiopia
| | - Sisay Dadi
- Department of Internal Medicine, Madda Walabu University Goba General Hospital, Goba, Ethiopia
| | - Mesfin Tsegaye
- Department of Medicine, Madda Walabu University Goba General Hospital, Goba, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, Madda Walabu University Goba General Hospital, Goba, Ethiopia
| | - Chala Kene
- Department of Midwifery, Madda Walabu University Goba General Hospital, Goba, Ethiopia
| | - Gudisa Tolosa
- Department of Medicine, Madda Walabu University Goba General Hospital, Goba, Ethiopia
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