Tongue

Oral traumatic ulcer

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

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
article

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.

Isolated neurofibroma of the tongue presenting as a papilloangiomatous mass

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

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.

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)
article

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.

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
article

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.

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.

Alveolar soft-part sarcoma of the tongue in a 17-month-old

September 30, 2009     Shahab Hillyer, MD, Jose C. Vicens, DMD, Howard Levinson, MD, Rajendra Bhayani, MD, Lilia Mesea, MD, Rashid Chaudhry, MD, Edgar Fayans, DDS, and Richard Fogler, MD
article

Abstract

Alveolar soft-part sarcoma (ASPS) is a rare and often fatal tumor. Overall survival rates have been reported to be 62% after 5 years, 42% after 10 years, and 18% after 20 years. ASPS accounts for 5% of all pediatric soft-tissue sarcomas other than rhabdomyosarcomas. In children, ASPS rarely occurs in the oral cavity, and to the best of our knowledge, only 12 cases of ASPS of the tongue occurring during the first decade of life have been previously reported in the literature. Because of the rarity of lingual ASPS in children, no specific treatment protocols have been developed, which makes its management difficult. We report a new case of lingual ASPS in a young child. Our patient was a 17-month-old girl whose tumor was located at the base of the tongue. She was successfully treated with surgical excision without adjuvant radiation or chemotherapy. Postoperatively, she has remained disease-free during 4 years of follow-up.

Ehlers-Danlos syndrome presenting as dysphonia and manifesting as tongue hypermobility: Report of 2 cases

February 1, 2009     Jeremy D. Richmon, MD, Jessica Wang-Rodriguez, MD, and Apurva A. Thekdi, MD
article

Abstract

Ehlers-Danlos syndrome (EDS) comprises a group of related hereditary connective tissue diseases. EDS manifests as joint hypermobility, tissue elasticity, and easy bruising. Although affected patients typically present to primary care physicians, orthopedists, and rheumatologists, some head and neck symptoms (e.g., dysphonia, dysphagia, and/or temporomandibular joint complaints) may direct some to an otolaryngologist. We describe the cases of 2 patients who presented to our otolaryngology clinic for evaluation of dysphonia. On physical examination, both exhibited tongue hypermobility, and both were subsequently diagnosed with EDS. We also review the results of our comprehensive literature search, in which we found only 3 articles that specifically described tongue hypermobility; in each case, the hypermobility was related to EDS. Finally, we discuss presentations of EDS that otolaryngologists might encounter.

Chondroid metaplasia mimicking recurrent squamous cell carcinoma of the head and neck

January 1, 2009     Shane K. Kohl, MD, Roger J. Simpson, MD, and James Wisecarver, MD, PhD
article

Abstract

A 65-year-old woman presented with a “sore bump” on her tongue. She had a history of squamous cell carcinoma of the head and neck that had been treated with surgery and radiotherapy 11 years earlier. The tongue lesion was excised, and pathologic examination identified a submucosal focus of benign-appearing cartilage. No evidence of dysplasia or malignancy was seen. She was diagnosed with chondroid metaplasia. Chondroid metaplasia involving the head and neck is rare. When it has occurred, it has been seen in both reactive and neoplastic settings. To our knowledge, this is the first reported case of a chondroid metaplasia of the tongue.

Surgical management of iatrogenic hypoglossal nerve injury

December 1, 2008     Sofia Avitia, MD and Ryan F. Osborne, MD, FACS
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