Tongue

Subglottic thyroglossal duct cyst: A rare intralaryngeal presentation

July 5, 2012     Regi Kurien, MS; Rajiv Michael, MS, DLO
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Abstract

Thyroglossal duct cysts are common midline neck swellings that can present at any site along their migratory pathway. They are frequently situated just below the hyoid bone. Extension to the subglottic area is very rare; such an unusual presentation can complicate the diagnosis of a thyroglossal duct cyst. We report the case of a 30-year-old man who presented with a subglottic thyroglossal duct cyst and associated laryngeal symptoms. To the best of our knowledge, only 2 similar cases have been previously reported in the literature, both of which occurred in 2-year-old boys. We believe, therefore, that ours is the first reported case of a subglottic thyroglossal duct cyst in an adult. We discuss the clinical presentation, diagnosis, and treatment of our patient, and we summarize the literature on intralaryngeal thyroglossal duct cysts.

Orofaciodigital syndrome

January 25, 2012     Baris Naiboglu, MD, Cagatay Oysu, MD, and Tanju Gokceer, MD
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Abstract

Orofaciodigital syndrome is a very rare entity with X-linked dominant inheritance characterized by oral, facial, and digital anomalies. Thirteen different types have been described in the literature to date. Of these, orofaciodigital syndrome type I has the highest incidence. Renal and central nervous system malformations may accompany the oral, facial, and digital anomalies. We report a case of orofaciodigital syndrome type I in a 9-year-old girl. The patient was admitted with a complaint unrelated to the syndrome. The coexistence of an oral anomaly with a digital anomaly in this patient led us to search for other possible anomalies. Ultrasonography revealed a diagnosis of polycystic kidneys. Physicians must be mindful of the external appearance of patients with this syndrome and be aware of life-threatening anomalies possibly associated with it.

Primary extranodal T-cell non-Hodgkin lymphoma of the tongue

January 25, 2012     J. Madana, MS, DNB, Deeke Yolmo, MS, Sunil Kumar Saxena, MS, and S. Gopalakrishnan, MS
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Abstract

The most common sites of extranodal non-Hodgkin lymphoma (NHL) are the gastrointestinal tract and the head and neck region. Head and neck involvement accounts for 8 to 13% of all extranodal lymphomas. Primary NHLs of the oral cavity, especially in the tongue, are extremely rare, which makes it difficult to understand their biologic behavior. Extranodal NHLs of the tongue usually present as a nodular lesion of the B-cell type. The T-cell variant of tongue NHL with an ulcerated exophytic presentation is extremely rare. We report such a case in a 37-year-old woman.

Glossal abscess as a complication of tongue-base suspension surgery

December 15, 2011     Bobby A. Tajudeen, MD, Biana G. Lanson, MD, and Pamela C. Roehm, MD, PhD
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Abstract

Approximately 60 cases of tongue abscess have been reported in the English-language literature over the past 30 years. We report what we believe is the first case of a glossal abscess that arose as a complication of tongue-base suspension surgery. The patient was a 31-year-old man who presented with a several-day history of odynophagia, tongue swelling, voice changes, and increased snoring. Two years earlier, he had undergone a tongue-base suspension procedure for the treatment of obstructive sleep apnea. Computed tomography (CT) revealed a tongue abscess. During peroral incision and drainage, a knotted 0 Prolene suture was discovered within the abscess cavity. The suture was removed, the area was thoroughly irrigated, the drain was placed in the abscess cavity, and the incision was loosely closed. On postoperative day 5, repeat CT revealed resolution of the abscess, and the patient was discharged on oral antibiotics. Although glossal abscess is very rare, physicians should consider it in the differential diagnosis of any patient who presents with lingual swelling following tongue-base suspension surgery.

Oral traumatic ulcer

November 22, 2011     Lester D.R. Thompson, MD

Unilateral macroglossia as sole presenting manifestation of internal carotid artery dissection

September 20, 2011     Joerg-Patrick Stübgen, MD
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Abstract

A patient presented with acute-onset, painless, unilateral enlargement of the tongue. Steroid treatment for angio-edema was ineffective, and a biopsy of an apparent mass of the tongue base showed normal tissue. Subsequent magnetic resonance imaging showed enlargement, enhancement, asymmetric T2 hyperintensity of the left half of the tongue, and dissection of the left cervical internal carotid artery (ICA) at the skull base. Unilateral enlargement of the tongue due to acute neurogenic denervation may be the sole clinical presentation of a spontaneous arterial dissection at the skull base. The hypoglossal neuropathy resulted from compression by the pseudoaneurysmal ICA dilatation or ischemia from interruption of the vasa nervorum.

Clear cell adenocarcinoma of the base of the tongue: A case report and review of the literature

April 30, 2011     Augusto Pietro Casani, MD, Manuela Marchetti, MD, Veronica Seccia, MD, Gabriella Fontanini, MD, Maria Elena Filice, MD, and Luca Muscatello, MD
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Abstract

Clear cell adenocarcinoma is an extremely rare tumor of the head and neck region. We report a case of a 75-year-old Caucasian woman with a 10-day history of hemoptysis but with no pain or other significant symptoms. A head and neck computed tomography scan with contrast medium showed an irregular, soft-tissue-like, irregularly enhanced lesion of the base of the tongue extending to its posterolateral portion. The tumor reached the lateral wall of the oropharynx, which showed a nonhomogeneous aspect. The patient underwent resection of the tumor via a conservative transmandibular approach. A clear cell adenocarcinoma of the base of the tongue is rarely a primary malignant lesion; it is more frequently a secondary lesion from a metastatic renal tumor. Because of this neoplasm's relatively slow growth rate and low incidence of metastasis or local recurrence, the gold standard of treatment is complete excision of the tumor with a sufficient tumor-free margin.

Warfarin-induced sublingual hematoma mimicking Ludwig angina: Conservative management of a potentially life-threatening condition

February 1, 2011     Emma Cashman, MD, MRCSI, Munish Shandilya, MD, FRCSI(ORL), Mohammed Amin, MD, FRCSI(ORL), Joe Hughes, MD, FRCSI(ORL), and Michael Walsh, MD, FRCSI(ORL)
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Abstract

Sublingual hematoma secondary to excessive anticoagulation is a rare, life-threatening condition. Reports in the literature have emphasized the importance of a prompt reversal of the causative coagulopathy by intravenous administration of vitamin K and fresh frozen plasma. In the event of an unstable airway, surgical intervention via tracheostomy or cricothyroidectomy is advocated. We report a case of sublingual hematoma that was treated conservatively, and we discuss the presentation and management of this entity.

Isolated neurofibroma of the tongue presenting as a papilloangiomatous mass

February 1, 2011     Mainak Dutta, MBBS and Soumya Ghatak, MS

Extramedullary plasmacytoma of the tongue base: A case report and clinical review of head and neck plasmacytoma

July 31, 2010     Haidar Alwan, BSc, MBChB, James W. Moor, MRCS, David Wright, MBChB;, Anastasios N. Kanatas, MRCS, PhD, and Helen E. Cruickshank, FRCS
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Abstract

Plasmacytomas of the head and neck are rare tumors characterized by a monoclonal proliferation of plasma cells. Very few cases of plasmacytoma of the tongue base have been reported. We present a new case of extramedullary plasmacytoma of the tongue base, we discuss its diagnosis and management, and we review the literature on plasmacytomas of the head and neck.

Intraglossal impaction of ingested fish bones: A case series

July 31, 2010     Shirish Johari, BSc, MBBS, DLO, DOHNS(Edin.), MRCSEd; and Kevin Yaw-Khian Chong, MBBS, FRCS(Ed), M Med(ORL-Singapore), FAMS(ORL), FAAOHNS(USA), EAONO, AINO(Italy)
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Abstract

Although foreign body ingestion and impaction in the pharynx or hypopharynx are quite commonly encountered at our institution, foreign body impaction in tongue tissue is rare. Six cases of foreign bodies embedded in the tongue were identified in a retrospective review spanning the years 1998 to 2007. All the foreign bodies were fish bones. Four of these patients required only tongue exploration to remove the bone; one required a partial glossectomy because of difficulties locating the bone; and one required incision and drainage of an intraglossal abscess that had developed, as well as a tracheostomy. All foreign bodies were successfully removed, with none of the patients experiencing altered sensation or problems with tongue mobility afterwards.

Double bilobed radial forearm free flap for anterior tongue and floor-of-mouth reconstruction

March 31, 2010     Alvin B. Ko, MD, Pierre Lavertu, MD, FRCS, FACS, and Rod P. Rezaee, MD
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Abstract

We describe what is, to the best of our knowledge, the first use of a double bilobed radial forearm free flap in reconstructive surgery of the tongue and floor of the mouth following bilateral tumor resection. Our patient was a 78-year-old man who had experienced tumor recurrence in the anterior floor of the mouth after previous resection and radiotherapy. Eleven weeks postoperatively, the patient could extend his tongue to his hard palate and past his mandibular alveolus anteriorly. Within 6 months, he was able to tolerate an oral diet of soft food and exhibited understandable speech quality. Although the use of a single bilobed radial forearm flap is widely used after hemiglossectomy, our double bilobed modification extends this technique to anterior tongue and floor-of-mouth defects. This technique provides adequate bulk while allowing for depth of a ventral sulcus that will minimize tethering of the tongue and reduce oral incompetence. We recommend that this technique be included in the armamentarium of any reconstructive head and neck cancer surgeon.

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