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A traumatic swollen tongue
Resuscitation 81 (2010) 267
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Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Image in resuscitation
A traumatic swollen tongue Bruce M. Lo a,b,∗ , Brian H. Campbell a a b
Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States Emergency Physicians of Tidewater, Virginia Beach, VA 23452, United States
a r t i c l e
i n f o
Article history: Received 9 December 2009 Received in revised form 11 December 2009 Accepted 17 December 2009
Fig. 1. Haematoma and swelling to the floor of mouth (white arrow) and elevation of tongue.
A 51-year-old male presented with tongue pain and swelling after a tonic–clonic seizure caused by alcohol withdrawal. The patient reported biting his tongue during the seizure and complained of progressive swelling to the tongue, difficulty swallowing saliva, and difficulty breathing. He was not taking any medications including anticoagulants and had a normal complete blood count and coagulation studies. He reported daily alcohol use and one previous alcohol withdrawal seizure 10 years ago. On examination there was a haematoma and swelling of the submandibular area with elevation of the tongue (Fig. 1). The patient was tiring, finding breathing difficult and was unable to swallow his own secretions. He therefore had an awake fibre-optic nasotracheal intubation for airway protection. A computed tomography scan of the neck showed severe oedema of the posterior oropharynx (Fig. 2). Subsequent treatment included steroids and the swelling resolved after
Fig. 2. Computed tomography showing swelling to the airway. A tracheal tube is in place (white arrow).
4 days. The patient’s trachea was extubated without difficulty and he was discharged home a week later. Haematoma of the tongue may be traumatic or spontaneous. When blood or infection fills the submandibular space, the floor of the mouth becomes full and the tongue is forced upwards and backwards, causing an elevation of the tongue and airway obstruction. Progressive swelling or respiratory distress requires early tracheal intubation or tracheostomy to protect the airway. While active arterial bleeding requires intervention, treatment is usually conservative with steroids, antibiotics, and reversal of any coagulopathy.1 Conflict of interest statement The authors have no conflicts of interest. Reference
∗ Corresponding author at: 600 Gresham Dr., Room 304, Raleigh Building, Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States. Tel.: +1 757 388 3397; fax: +1 757 388 2885. E-mail address: [email protected] (B.M. Lo). 0300-9572/$ – see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.resuscitation.2009.12.013
1. Song Z, Laggan B, Parulis A. Lingual hematoma treatment rationales: a case report. J Oral Maxillofac Surg 2008;66:535–9.
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Image in resuscitation
A traumatic swollen tongue Bruce M. Lo a,b,∗ , Brian H. Campbell a a b
Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States Emergency Physicians of Tidewater, Virginia Beach, VA 23452, United States
a r t i c l e
i n f o
Article history: Received 9 December 2009 Received in revised form 11 December 2009 Accepted 17 December 2009
Fig. 1. Haematoma and swelling to the floor of mouth (white arrow) and elevation of tongue.
A 51-year-old male presented with tongue pain and swelling after a tonic–clonic seizure caused by alcohol withdrawal. The patient reported biting his tongue during the seizure and complained of progressive swelling to the tongue, difficulty swallowing saliva, and difficulty breathing. He was not taking any medications including anticoagulants and had a normal complete blood count and coagulation studies. He reported daily alcohol use and one previous alcohol withdrawal seizure 10 years ago. On examination there was a haematoma and swelling of the submandibular area with elevation of the tongue (Fig. 1). The patient was tiring, finding breathing difficult and was unable to swallow his own secretions. He therefore had an awake fibre-optic nasotracheal intubation for airway protection. A computed tomography scan of the neck showed severe oedema of the posterior oropharynx (Fig. 2). Subsequent treatment included steroids and the swelling resolved after
Fig. 2. Computed tomography showing swelling to the airway. A tracheal tube is in place (white arrow).
4 days. The patient’s trachea was extubated without difficulty and he was discharged home a week later. Haematoma of the tongue may be traumatic or spontaneous. When blood or infection fills the submandibular space, the floor of the mouth becomes full and the tongue is forced upwards and backwards, causing an elevation of the tongue and airway obstruction. Progressive swelling or respiratory distress requires early tracheal intubation or tracheostomy to protect the airway. While active arterial bleeding requires intervention, treatment is usually conservative with steroids, antibiotics, and reversal of any coagulopathy.1 Conflict of interest statement The authors have no conflicts of interest. Reference
∗ Corresponding author at: 600 Gresham Dr., Room 304, Raleigh Building, Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States. Tel.: +1 757 388 3397; fax: +1 757 388 2885. E-mail address: [email protected] (B.M. Lo). 0300-9572/$ – see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.resuscitation.2009.12.013
1. Song Z, Laggan B, Parulis A. Lingual hematoma treatment rationales: a case report. J Oral Maxillofac Surg 2008;66:535–9.