What are the symptoms of a tongue abscess. How is a tongue abscess diagnosed and treated. What factors can increase the risk of developing a tongue abscess. What complications can arise from an untreated tongue abscess.

Understanding Tongue Abscesses: A Rare but Potentially Dangerous Oral Condition

Tongue abscesses are uncommon oral infections that can pose serious health risks if left untreated. Despite the tongue’s natural defenses against infection, certain circumstances can lead to the formation of these painful, pus-filled lesions. Understanding the causes, symptoms, and treatment options for tongue abscesses is crucial for early detection and proper management.

Symptoms and Clinical Presentation of Tongue Abscesses

Recognizing the signs of a tongue abscess is essential for timely intervention. The symptoms typically include:

• Severe tongue pain and swelling
• Difficulty swallowing (dysphagia)
• Pain that radiates to the ears
• Fever and chills
• Difficulty opening the mouth (trismus)
• Shortness of breath in severe cases
• Drooling or excessive salivation
• Headache

In the case study presented, a 50-year-old male patient exhibited many of these classic symptoms, including severe tongue pain and swelling lasting for three days, accompanied by fever, difficulty swallowing, and breathing issues.

How can you differentiate a tongue abscess from other oral conditions?

Distinguishing a tongue abscess from other oral conditions requires a careful examination and consideration of symptoms. Unlike canker sores or viral infections, tongue abscesses typically present as a localized swelling that feels fluctuant (fluid-filled) upon palpation. The presence of systemic symptoms like fever and the severity of pain and swelling can also help differentiate an abscess from less serious conditions.

Causes and Risk Factors for Tongue Abscesses

While the tongue’s natural defenses usually prevent infections, certain factors can increase the risk of abscess formation:

1. Poor oral hygiene
2. Trauma to the tongue
3. Dental infections or procedures
4. Compromised immune system
5. Foreign body penetration
6. Certain habits (e.g., khat chewing)

In the case study, the patient’s history of poor oral hygiene, severe dental pain, and long-term khat chewing likely contributed to the development of the abscess.

Can certain lifestyle habits increase the risk of tongue abscesses?

Yes, certain lifestyle habits can indeed increase the risk of developing tongue abscesses. Practices that compromise oral health or introduce harmful substances into the mouth can create favorable conditions for bacterial growth and infection. For example:

• Tobacco use (smoking or chewing)
• Excessive alcohol consumption
• Chewing stimulant plants like khat
• Neglecting proper oral hygiene
• Consuming a diet high in sugar and processed foods

These habits can weaken the natural defenses of the oral cavity, damage the tongue’s protective surface, or introduce harmful bacteria, all of which can increase the likelihood of abscess formation.

Diagnostic Approaches for Tongue Abscesses

Accurate diagnosis of a tongue abscess is crucial for appropriate treatment. The diagnostic process typically involves:

1. Thorough medical history
2. Physical examination of the oral cavity
3. Imaging studies (e.g., ultrasound, CT scan)
4. Laboratory tests (e.g., blood tests, culture of abscess fluid)

In the case study, the diagnosis was primarily based on the patient’s symptoms and physical examination findings, which revealed a significant swelling on the left anterolateral area of the tongue that was fluctuant on palpation and had an erythematous border.

How effective is ultrasound in diagnosing tongue abscesses?

Ultrasound can be a highly effective tool in diagnosing tongue abscesses. It offers several advantages:

• Non-invasive and radiation-free
• Can differentiate between solid masses and fluid-filled lesions
• Helps determine the size and exact location of the abscess
• Can guide needle aspiration or drainage procedures
• Allows real-time visualization during treatment

While not mentioned in the case study, ultrasound is increasingly being used in dental and oral medicine for diagnosing various conditions, including abscesses, due to its accuracy and safety.

Treatment Options and Management of Tongue Abscesses

The primary goals in treating tongue abscesses are to eliminate the infection, prevent complications, and relieve symptoms. Treatment typically involves:

1. Incision and drainage of the abscess
2. Antibiotic therapy
3. Pain management
4. Supportive care (e.g., oral hygiene, hydration)

In the presented case, the patient underwent incision and drainage under general anesthesia, with approximately 30mL of thick pus removed. The abscess cavity was then irrigated with normal saline and hydrogen peroxide. Post-procedure, the patient received antibiotic therapy and was discharged after two days of hospital stay.

What factors determine the choice between conservative management and surgical intervention for tongue abscesses?

The decision between conservative management and surgical intervention for tongue abscesses depends on several factors:

• Size and location of the abscess
• Severity of symptoms
• Presence of airway compromise
• Response to initial antibiotic therapy
• Patient’s overall health status

Generally, smaller abscesses may respond to antibiotics alone, while larger or more severe abscesses often require surgical drainage. In cases where there’s a risk of airway obstruction or rapid progression of infection, immediate surgical intervention is usually necessary.

Potential Complications of Untreated Tongue Abscesses

If left untreated, tongue abscesses can lead to serious complications, including:

• Airway obstruction
• Spread of infection to adjacent structures
• Ludwig’s angina (a severe infection of the floor of the mouth)
• Sepsis
• Necrotizing fasciitis

The case study emphasizes the importance of prompt diagnosis and treatment to prevent these potentially life-threatening complications.

How quickly can a tongue abscess progress to airway obstruction?

The progression of a tongue abscess to airway obstruction can vary depending on factors such as the size and location of the abscess, the virulence of the infecting organisms, and the patient’s immune response. In some cases, this progression can be rapid, occurring within hours to days. Signs of impending airway compromise include:

• Increasing difficulty breathing
• Stridor (high-pitched breathing sound)
• Inability to swallow saliva
• Muffled voice or inability to speak
• Rapidly worsening swelling

Given the potential for rapid deterioration, any signs of breathing difficulty in a patient with a tongue abscess should be treated as a medical emergency requiring immediate intervention.

Prevention Strategies and Long-term Management

Preventing tongue abscesses and managing long-term oral health involves several key strategies:

1. Maintaining good oral hygiene
2. Regular dental check-ups and cleanings
3. Prompt treatment of dental infections
4. Avoiding harmful habits (e.g., tobacco use, excessive alcohol consumption)
5. Managing underlying health conditions that may compromise immunity

In the case of the patient in the study, addressing his poor oral hygiene, treating his dental decay, and considering cessation of khat chewing would be important steps in preventing future oral infections.

How can individuals with a history of tongue abscesses reduce their risk of recurrence?

Individuals with a history of tongue abscesses can take several steps to reduce their risk of recurrence:

• Follow a rigorous oral hygiene routine, including regular brushing, flossing, and use of antiseptic mouthwashes
• Attend regular dental check-ups to address any developing dental issues promptly
• Avoid habits that can damage oral tissues or introduce harmful bacteria, such as tobacco use or chewing stimulant plants
• Maintain a healthy diet and lifestyle to support overall immune function
• Be vigilant for early signs of oral infections and seek prompt medical attention if symptoms develop
• Follow through with any prescribed treatments or follow-up appointments after an abscess episode

By implementing these preventive measures, individuals can significantly reduce their risk of experiencing recurrent tongue abscesses and maintain better overall oral health.

The Role of Imaging in Tongue Abscess Diagnosis and Management

While not explicitly mentioned in the case study, imaging plays a crucial role in the diagnosis and management of tongue abscesses. Various imaging modalities can be employed, each offering unique advantages:

• Ultrasound: As mentioned earlier, this non-invasive technique can accurately identify and characterize abscesses.
• CT (Computed Tomography) scan: Provides detailed cross-sectional images, useful for assessing the extent of the abscess and its relationship to surrounding structures.
• MRI (Magnetic Resonance Imaging): Offers excellent soft tissue contrast, helpful in differentiating abscesses from other types of lesions.

How does CT imaging contribute to the management of complex tongue abscesses?

CT imaging can significantly enhance the management of complex tongue abscesses in several ways:

1. Precise localization: CT scans provide detailed 3D images, allowing clinicians to pinpoint the exact location and extent of the abscess.
2. Assessment of surrounding structures: It helps evaluate any involvement or potential spread to adjacent tissues.
3. Surgical planning: The detailed images assist surgeons in planning the most effective and least invasive approach for drainage.
4. Identification of complications: CT can reveal complications such as deep space infections or vascular involvement.
5. Monitoring treatment response: Follow-up CT scans can assess the effectiveness of interventions and guide further management.

While CT imaging involves radiation exposure, its benefits often outweigh the risks in cases of complex or deep-seated tongue abscesses, particularly when ultrasound findings are inconclusive or when there’s suspicion of more extensive infection.

Tongue Abscess: A Case Report

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Published online 2022 Dec 30. doi: 10.2147/IMCRJ.S399020

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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.

Keywords: tongue abscess, khat chewing, sonography

Abscess of the tongue is a very rare disease that potentially compromises the airway.¹ The tongue’s strong keratinized epithelium, the density of its muscle compartments, its rich vasculature, and the bactericidal properties of saliva all serve to prevent infection.² However, when host defense mechanisms are impaired, tongue abscesses are more likely to occur. Breached surface barriers, foreign bodies, and immunodeficiency states predispose to tongue infections. ³ 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.⁴ Therefore, it is crucial to identify tongue infections as soon as possible and treat them as an emergency, especially if dyspnea and dysphagia are present. In particular, if left untreated, abscesses around the root of the tongue could be lethal.⁵ These lesions should be opened and drained once diagnosed.⁶

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. Otherwise, he had no trauma to his tongue, no recent dental or oral procedures, no history of cigarette smoking, and no history of chronic medical illness like diabetes mellitus, cardiac disease, and hypertension. Historically, he had severe standing dental pain for the past six months prior to his current complaint. He has been chewing khat since his childhood and had poor oral hygiene.

On physical examination, he was acutely sick looking and his vital signs were, blood pressure 115 by 70 mmHg, pulse rate 120 beats per minute, respiratory rate 20, temperature 39 degrees centigrade, and oxygen saturation 92% off oxygen. On HEENT examination there was significant tongue swelling on the left anterolateral area, fluctuant on palpation, and had a erythematous border (). There is multiple teeth decay in both maxillary and mandibular areas. There were no pertinent findings on the remaining systems.

Open in a separate window

Swollen tongue on the left anterolateral border found during physical examination.

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 ceftriaxone 1 gm iv twice daily (BID) and metronidazole 500 mg iv three times per day (TID) for two days. He was discharged after two days of hospital stay with improvement and Augmentin 625 mg PO TID for five days.

Abscesses in the tongue are quite uncommon that occur in immunocompromised patients or healthy persons with pierced tongues.³ Although the tongue is exposed to numerous possible pathogens, it is comparatively immune to infection.⁴ The regular movement of the tongue, which enables the saliva to continuously generate a cleansing effect, as well as its thick layer of keratinized mucosa, which is resistant to microbial penetration; muscle tissue, which makes up the majority of its parenchyma and with its rich circulatory supply; rich lymphatic drainage; and saliva’s immunologic characteristics.^7,8

A variety of conditions, including tumors, cysts, infarctions, edema, infections, hemorrhages, metabolic macroglossia in hyperpituitarism or hypothyroidism, developmental macroglossia in lingual thyroid, and ectopic lymphoid tissue are included in the differential diagnosis of tongue abscess. ^9,10 Most tongue abscesses are unilateral and located in the anterior two-thirds of the tongue.¹¹ The same is true for this patient which is located in the left anterolateral part of the tongue. A painful swelling that causes the tongue to protrude, dysphagia, odynophagia, and speech impairment are common symptoms of tongue abscesses.^12,13 The current patient also experienced severe tongue pain and swelling. Along with this, he experienced pain while swallowing, trouble opening his mouth, shortness of breath, and dribbling of saliva. He also had a high-grade fever and headache. The possible explanation for the abscess may be long-standing poor oral hygiene. This might be due to the fact that the patient was chewing the khat since his childhood.

There are two forms of tongue abscess; superficial and deep. The inflammatory process of a superficial abscess is situated right below the mucosal membrane. The back of the tongue is the primary place. It is uncomfortable to touch and is dense and swollen. With such a configuration, a pathological focus can open and spontaneously drain. After that, the patient feels a reduction in pain and a decrease in swelling. Even though the tongue wound might epithelialize fast, an abscess relapse is likely if the lesion is not properly treated.⁶ The inflammation of the deep tongue muscle tissue is a characteristic of deep abscesses. The course is more severe, with a 38 to 39 degree centigrade temperature, overall weakness, appetite loss, and headaches. A thorough physical examination reveals a significant increase in swelling of the tongue. This could impair speech and food intake. In severe circumstances, the patient has trouble even drinking liquids or breathing through their mouth. Patients with severe conditions can appear with upper airway blockage that necessitates an emergency tracheostomy.⁸ Typically, submandibular lymph nodes expand quickly, becoming painful yet movable. ⁶

Sonography, CT, and MR imaging are just a few of the imaging methods that can be utilized to assess tongue swellings.^7,8,10 Although vascular lesions and abscesses are defined and distinguished by ultrasonography, using the transducer in the mouth is challenging.¹⁴ It has been observed that a lingual abscess appears on sonography as a hypoechoic lesion surrounded by a hyperechoic ring. However, sonography is not always practical since if the tongue is swollen and squeezed, the patient may feel discomfort or severe pain.^7,8

A correct diagnosis is the first step in the successful treatment of tongue abscesses, which also includes maintaining the airway, performing an incision, and drainage. Next, the proper antibiotic therapy should target Streptococci, Staphylococci, and Gram-negative anaerobes. Since continuous nidus of infection can cause an abscess to return, aspiration alone is frequently insufficient therapy and must be combined with incision and drainage. ⁶

Abscesses in the tongue are quite uncommon due to its rich circulatory supply; lymphatic drainage; and saliva’s immunologic characteristics. Thorough diagnosis and successful treatment of tongue abscess include maintaining the airway, performing an incision, and drainage. Antibiotic treatment should cover gram-positive and gram-negative anaerobes.

There is no funding to report.

Data on the case clinical information, informed consent form, and images are available for review from the corresponding author upon request.

No ethical approval is required for this case report.

Informed written consent was taken from the patient.

The authors declare that there are no conflicts of interest in this work.

1. Awai S. Lingual tonsil abscess: a rare, life-threatening cause of acute sore throat. BMJ Case Rep. 2019. doi: 10.1136/bcr-2019-229555 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

2. Balatsouras DG, Eliopoulos PN, Kaberos AC. Lingual abscess: diagnosis and treatment. Head Neck. 2004;26(6):550–554. doi: 10.1002/hed.20018 [PubMed] [CrossRef] [Google Scholar]

3. Antoniades K, Hadjipetrou L, Antoniades V, et al. Acute tongue abscess. Report of three cases. Oral Surg. 2004;97(5):570–573. doi: 10.1016/j.tripleo.2003.11.011 [PubMed] [CrossRef] [Google Scholar]

4. Ozturk M, Mavili E, Erdogan N, et al. Tongue abscesses: MR imaging findings. Am J Neuroradiol. 2006;27(6):1300–1303. [PMC free article] [PubMed] [Google Scholar]

5. Pallagatti S, Sheikh S, Kaur A, et al. Tongue abscess: a rare clinical entity. J Investig Clin Dent. 2012;3(3):240–243. doi: 10.1111/j.2041-1626.2011.00101.x [PubMed] [CrossRef] [Google Scholar]

6. Mesolella M, Allosso S, Iorio B, et al. Clinical and diagnostic aspect of tongue abscess. Ear Nose Throat J. 2021;100(10_suppl):1012S–1014S. doi: 10.1177/0145561320933961 [PubMed] [CrossRef] [Google Scholar]

7. Ozturk M, Durak AC, Ozcan N, et al. Abscess of the tongue: findings on MR imaging. Am J Roentgenol. 1998;170(3):797–798. doi: 10.2214/ajr.170.3.9490978 [PubMed] [CrossRef] [Google Scholar]

8. Munoz A, Ballesteros AI, Castelo JB. Primary lingual abscess presenting as acute swelling of the tongue obstructing the upper airway: diagnosis with MR. Am J Neuroradiol. 1998;19(3):496–498. [PMC free article] [PubMed] [Google Scholar]

9. Rubin MM, Gatta CA, Cozzi GM, et al. Painful tongue mass. J Oral Maxillofacial Surg. 1990;48(7):728–731. doi: 10.1016/0278-2391(90)90059-B [PubMed] [CrossRef] [Google Scholar]

10. Renehan A, Morton M. Acute enlargement of the tongue. Br J Oral Maxillofacial Surg. 1993;31(5):321–324. doi: 10.1016/0266-4356(93)90071-4 [PubMed] [CrossRef] [Google Scholar]

11. Schweigert J, Christian R, Kemp WL. Challenges in the diagnosis of a posterior lingual abscess, a potential lethal disorder: a case report and review of the literature. Am J Forensic Med Pathol. 2020;41(1):64–66. doi: 10.1097/PAF.0000000000000514 [PubMed] [CrossRef] [Google Scholar]

12. Mesolella M, Ricciardiello F, Cavaliere M, et al. Papillary carcinoma arising in a submental intralingual thyroglossal duct cyst. Acta Otorhinolaryngologica Italica. 2010;30(6):313–316. [PMC free article] [PubMed] [Google Scholar]

13. Srivanitchapoom C, Yata K. Lingual abscess: predisposing factors, pathophysiology, clinical manifestations, diagnosis, and management. Int J Otolaryngol. 2018;2018:1–8. doi: 10.1155/2018/4504270 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

14. Pandey MK, Srivastava A, Kushwaha RAS, et al. Tongue is an unusual site of abscess development-an experience of two cases. The Indian Journal of Tuberculosis. 2016;64:47–49. doi: 10.1016/j.ijtb.2016.06.004 [PubMed] [CrossRef] [Google Scholar]

Articles from International Medical Case Reports Journal are provided here courtesy of Dove Press

Tongue abscess: A case report

Telila Mesfin,¹ Gosaye Debele,² Kenbon Seyoum,³ Sisay Dadi,⁴ Mesfin Tsegaye,¹ Degefa Gomora,³ Chala Kene,³ Gudisa Tolosa¹

¹Department of Medicine, Madda Walabu University Goba General Hospital, Goba, Ethiopia; ²Department of Surgery, Madda Walabu University Goba General Hospital, Goba, Ethiopia; ³Department of Midwifery, Madda Walabu University Goba General Hospital, Goba, Ethiopia; ⁴Department of Internal Medicine, Madda Walabu University Goba General Hospital, Goba, Ethiopia

Correspondence: Telila Mesfin, Tel +251931504321, Email [email protected]

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.

Keywords: tongue abscess, khat chewing, sonography

Introduction

Abscess of the tongue is a very rare disease that potentially compromises the airway.¹ The tongue’s strong keratinized epithelium, the density of its muscle compartments, its rich vasculature, and the bactericidal properties of saliva all serve to prevent infection.² However, when host defense mechanisms are impaired, tongue abscesses are more likely to occur. Breached surface barriers, foreign bodies, and immunodeficiency states predispose to tongue infections. ³ 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.⁴ Therefore, it is crucial to identify tongue infections as soon as possible and treat them as an emergency, especially if dyspnea and dysphagia are present. In particular, if left untreated, abscesses around the root of the tongue could be lethal.⁵ These lesions should be opened and drained once diagnosed.⁶

Clinical Presentation

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. Otherwise, he had no trauma to his tongue, no recent dental or oral procedures, no history of cigarette smoking, and no history of chronic medical illness like diabetes mellitus, cardiac disease, and hypertension. Historically, he had severe standing dental pain for the past six months prior to his current complaint. He has been chewing khat since his childhood and had poor oral hygiene.

On physical examination, he was acutely sick looking and his vital signs were, blood pressure 115 by 70 mmHg, pulse rate 120 beats per minute, respiratory rate 20, temperature 39 degrees centigrade, and oxygen saturation 92% off oxygen. On HEENT examination there was significant tongue swelling on the left anterolateral area, fluctuant on palpation, and had a erythematous border (Figure 1). There is multiple teeth decay in both maxillary and mandibular areas. There were no pertinent findings on the remaining systems.

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 ceftriaxone 1 gm iv twice daily (BID) and metronidazole 500 mg iv three times per day (TID) for two days. He was discharged after two days of hospital stay with improvement and Augmentin 625 mg PO TID for five days.

Discussion

Abscesses in the tongue are quite uncommon that occur in immunocompromised patients or healthy persons with pierced tongues.³ Although the tongue is exposed to numerous possible pathogens, it is comparatively immune to infection.⁴ The regular movement of the tongue, which enables the saliva to continuously generate a cleansing effect, as well as its thick layer of keratinized mucosa, which is resistant to microbial penetration; muscle tissue, which makes up the majority of its parenchyma and with its rich circulatory supply; rich lymphatic drainage; and saliva’s immunologic characteristics. ^7,8

A variety of conditions, including tumors, cysts, infarctions, edema, infections, hemorrhages, metabolic macroglossia in hyperpituitarism or hypothyroidism, developmental macroglossia in lingual thyroid, and ectopic lymphoid tissue are included in the differential diagnosis of tongue abscess.^9,10 Most tongue abscesses are unilateral and located in the anterior two-thirds of the tongue.¹¹ The same is true for this patient which is located in the left anterolateral part of the tongue. A painful swelling that causes the tongue to protrude, dysphagia, odynophagia, and speech impairment are common symptoms of tongue abscesses.^12,13 The current patient also experienced severe tongue pain and swelling. Along with this, he experienced pain while swallowing, trouble opening his mouth, shortness of breath, and dribbling of saliva. He also had a high-grade fever and headache. The possible explanation for the abscess may be long-standing poor oral hygiene. This might be due to the fact that the patient was chewing the khat since his childhood.

There are two forms of tongue abscess; superficial and deep. The inflammatory process of a superficial abscess is situated right below the mucosal membrane. The back of the tongue is the primary place. It is uncomfortable to touch and is dense and swollen. With such a configuration, a pathological focus can open and spontaneously drain. After that, the patient feels a reduction in pain and a decrease in swelling. Even though the tongue wound might epithelialize fast, an abscess relapse is likely if the lesion is not properly treated.⁶ The inflammation of the deep tongue muscle tissue is a characteristic of deep abscesses. The course is more severe, with a 38 to 39 degree centigrade temperature, overall weakness, appetite loss, and headaches. A thorough physical examination reveals a significant increase in swelling of the tongue. This could impair speech and food intake. In severe circumstances, the patient has trouble even drinking liquids or breathing through their mouth. Patients with severe conditions can appear with upper airway blockage that necessitates an emergency tracheostomy.⁸ Typically, submandibular lymph nodes expand quickly, becoming painful yet movable.⁶

Sonography, CT, and MR imaging are just a few of the imaging methods that can be utilized to assess tongue swellings.^7,8,10 Although vascular lesions and abscesses are defined and distinguished by ultrasonography, using the transducer in the mouth is challenging.¹⁴ It has been observed that a lingual abscess appears on sonography as a hypoechoic lesion surrounded by a hyperechoic ring. However, sonography is not always practical since if the tongue is swollen and squeezed, the patient may feel discomfort or severe pain.^7,8

A correct diagnosis is the first step in the successful treatment of tongue abscesses, which also includes maintaining the airway, performing an incision, and drainage. Next, the proper antibiotic therapy should target Streptococci, Staphylococci, and Gram-negative anaerobes. Since continuous nidus of infection can cause an abscess to return, aspiration alone is frequently insufficient therapy and must be combined with incision and drainage.⁶

Conclusion

Abscesses in the tongue are quite uncommon due to its rich circulatory supply; lymphatic drainage; and saliva’s immunologic characteristics. Thorough diagnosis and successful treatment of tongue abscess include maintaining the airway, performing an incision, and drainage. Antibiotic treatment should cover gram-positive and gram-negative anaerobes.

Data Sharing Statement

Data on the case clinical information, informed consent form, and images are available for review from the corresponding author upon request.

Ethical Approval

No ethical approval is required for this case report.

Consent

Informed written consent was taken from the patient.

Funding

There is no funding to report.

Disclosure

The authors declare that there are no conflicts of interest in this work.

References

1. Awai S. Lingual tonsil abscess: a rare, life-threatening cause of acute sore throat. BMJ Case Rep. 2019. doi:10.1136/bcr-2019-229555

2. Balatsouras DG, Eliopoulos PN, Kaberos AC. Lingual abscess: diagnosis and treatment. Head Neck. 2004;26(6):550–554. doi:10.1002/hed.20018

3. Antoniades K, Hadjipetrou L, Antoniades V, et al. Acute tongue abscess. Report of three cases. Oral Surg. 2004;97(5):570–573. doi:10.1016/j.tripleo.2003.11.011

4. Ozturk M, Mavili E, Erdogan N, et al. Tongue abscesses: MR imaging findings. Am J Neuroradiol. 2006;27(6):1300–1303.

5. Pallagatti S, Sheikh S, Kaur A, et al. Tongue abscess: a rare clinical entity. J Investig Clin Dent. 2012;3(3):240–243. doi:10.1111/j.2041-1626.2011.00101.x

6. Mesolella M, Allosso S, Iorio B, et al. Clinical and diagnostic aspect of tongue abscess. Ear Nose Throat J. 2021;100(10_suppl):1012S–1014S. doi:10.1177/0145561320933961

7. Ozturk M, Durak AC, Ozcan N, et al. Abscess of the tongue: findings on MR imaging. Am J Roentgenol. 1998;170(3):797–798. doi:10.2214/ajr.170.3.9490978

8. Munoz A, Ballesteros AI, Castelo JB. Primary lingual abscess presenting as acute swelling of the tongue obstructing the upper airway: diagnosis with MR. Am J Neuroradiol. 1998;19(3):496–498.

9. Rubin MM, Gatta CA, Cozzi GM, et al. Painful tongue mass. J Oral Maxillofacial Surg. 1990;48(7):728–731. doi:10.1016/0278-2391(90)90059-B

10. Renehan A, Morton M. Acute enlargement of the tongue. Br J Oral Maxillofacial Surg. 1993;31(5):321–324. doi:10.1016/0266-4356(93)90071-4

11. Schweigert J, Christian R, Kemp WL. Challenges in the diagnosis of a posterior lingual abscess, a potential lethal disorder: a case report and review of the literature. Am J Forensic Med Pathol. 2020;41(1):64–66. doi:10.1097/PAF.0000000000000514

12. Mesolella M, Ricciardiello F, Cavaliere M, et al. Papillary carcinoma arising in a submental intralingual thyroglossal duct cyst. Acta Otorhinolaryngologica Italica. 2010;30(6):313–316.

13. Srivanitchapoom C, Yata K. Lingual abscess: predisposing factors, pathophysiology, clinical manifestations, diagnosis, and management. Int J Otolaryngol. 2018;2018:1–8. doi:10.1155/2018/4504270

14. Pandey MK, Srivastava A, Kushwaha RAS, et al. Tongue is an unusual site of abscess development-an experience of two cases. The Indian Journal of Tuberculosis. 2016;64:47–49. doi:10.1016/j.ijtb.2016.06.004

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Glossitis: symptoms, treatment, prevention

Hygienist

Savinova

Natalia Faritovna

Experience 33 years

Hygienist

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Glossitis is an inflammatory process that affects the tongue. Pathology is accompanied by a change in the color and structure of the tissues of the organ. Patients experience pain and burning, salivation increases, taste sensations change while eating habitual food. When the gloss is running, there are difficulties with swallowing, speech becomes illegible. Lack of treatment can lead to the formation of neck phlegmon. Chronic glossitis is accompanied by the appearance on the tongue of formations similar to papillomas.

Causes of inflammation of the tongue

The inflammatory process in the tissues of the tongue can develop as an independent disease against the background of a bacterial infection or manifest itself as a symptom of a systemic pathology. Local glossitis is often the result of viral infections.

A burn of the oral cavity provokes the development of inflammatory processes that can affect the tongue. Similarly, mechanical injuries act on the tissues of the organ, becoming a favorable environment for the active growth of bacteria. The risk group includes patients prone to the systematic use of alcohol and smoking.

Glossitis is one of the main symptoms of poisoning with salts of heavy metals. An acute reaction can develop when using someone else’s toothbrushes or frequent use of mouth rinses.

Symptoms of glossitis often develop against the background of damage to the tongue on the sharp edges of decayed teeth, elements of prostheses or braces. Chemical irritants contribute to the development of oral dysbacteriosis. Imbalance of the microflora causes the transition of glossitis to the chronic stage.

Symptoms of pathology

The primary manifestations of glossitis are specific, which simplifies the diagnosis of the disease. The patient experiences the following symptoms:

• burning;
• foreign body sensation in the mouth;
• swelling of the tongue;
• increased salivation;
• dulling of taste sensations.

The increase in symptoms leads to the illegibility of the speech of a person suffering from glossitis. The pain syndrome acquires a pronounced intensity, swallowing food causes discomfort in the patient.

Lack of treatment contributes to the development of chronic glossitis, which is accompanied by persistent swelling of the tongue and a change in its structure. Mushroom-shaped growths form on the outer surface of the muscle tissue.

Complicated glossitis is accompanied by the formation of abscesses. A child or adult feels systematic bouts of throbbing pain. Swelling appears in the area of ​​the future abscess, the tongue acquires a pronounced asymmetry.

Often glossitis is complicated by phlegmon. Purulent fusion of tissues affects the oral cavity and neck of the patient. The pain syndrome is characterized by high intensity. The process of chewing food is completely disturbed, the patient refuses to eat. There are signs of intoxication: weakness, fever, inflammation of the regional lymph nodes.

Classification of pathology

The clinical recommendations of the Ministry of Health contain a description of several forms of glossitis. Differentiation is important in making a diagnosis, as different types of pathology require different approaches to treating patients.

Diagnostic procedures

Glossitis has a specific clinical picture, which allows dentists to make a diagnosis after a visual examination of the patient’s oral cavity. Establishing the causes of inflammation of the tissues of the tongue may require cytological and histological studies in the laboratory. Often, the dentist refers the patient to a gastroenterologist to identify the underlying disease that provoked the appearance of glossitis.

Pathology treatment

Therapeutic measures are aimed at eliminating the symptoms of glossitis and treating the underlying diseases that provoked the development of the inflammatory process in the tissues of the tongue.

A special diet, including pureed soups, mucous porridges and mashed potatoes, contributes to a decrease in the intensity of the pain syndrome when eating food. Rinsing the mouth with a solution of furacilin or potassium permanganate is designed to reduce the intensity of the inflammatory process and eliminate foci of active growth of pathogenic microflora. With severe pain, the patient is prescribed applications of anesthetics on the tongue.

Prognosis and prevention

Timely treatment of glossitis and the underlying disease allows you to count on a complete recovery of the patient. An unfavorable prognosis is formed when the pathology is complicated by phlegmon, abscesses or malignant neoplasms.

Prevention of glossitis involves compliance with hygiene standards. Patients at risk are advised to visit the dentist regularly. Excessively spicy foods should be excluded from the diet. Quitting smoking and drinking strong alcohol reduces the likelihood of glossitis.

Questions and answers

At what age is it most likely to develop glossitis?

Glossitis can develop in patients of any age. The risk group is formed from smokers and people suffering from chronic gastrointestinal pathologies.

What is dangerous chronic glossitis?

The chronic course of the pathology is characterized by regular exacerbations. The patient experiences discomfort, loses the ability to understand speech. Launched glossitis can lead to the formation of an abscess or phlegmon.

Glossitis of the tongue – causes, treatment and prevention of the disease

The tongue is quite often injured. Sometimes these damages are so insignificant that we do not notice them, but these mucosal defects are the entrance gate for infection. Glossitis is an inflammation of the tongue that is caused by various bacteria and viruses. The disease causes a number of unpleasant symptoms that interfere with normal eating, and sometimes even interfere with talking. Glossitis is dangerous for its complications. If measures are not taken in time, then diffuse purulent inflammation may occur, spreading far beyond the oral cavity.

The disease is very common. Most often occurs in people with reduced immunity, smokers, patients who do not pay due attention to oral hygiene.

Forms

Varieties of glossitis:

• deep;
• desquamative;
• diamond-shaped;
• hairy;
• pleated;
• hunter’s;
• syphilitic or interstitial.

The most dangerous is deep glossitis. The pathological process begins on the lower part of the tongue, if left untreated, it spreads to the bottom of the oral cavity. In the case of abscess formation, the purulent process can pass to the neck, which is a life-threatening condition.

Desquamative glossitis is better known as geographic language. Irregularly shaped peeling areas alternate with normal ones, so the tongue looks like a geographical map. This type of disease is typical for patients with chronic lesions of the digestive system, allergies, helminthic invasions, and can also occur during pregnancy.

Diamond-shaped lesions are characteristic of patients with chronic gastropathology. The disease is recurrent.

Villous glossitis occurs due to hypertrophy of the papillae of the tongue. This disease is one of the manifestations of a fungal infection – candidiasis, and can also occur in smokers.

The disease may be congenital. These anomalies include the folded form. Such glossitis does not cause unpleasant symptoms and does not require special treatment.

Gunter’s tongue is not an independent pathology, but one of the manifestations caused by anemia resulting from a lack of vitamin B 12 and folic acid in the body. The disease develops gradually. The mucous membrane of the tongue becomes smooth, the papillae decrease in size, the tongue acquires a crimson hue.

Interstitial glossitis is also a secondary manifestation and is characteristic of patients with syphilis. The pathological process proceeds deeply, affecting the muscle tissue. If left untreated, the muscles are replaced by connective tissue, which is an irreversible process. This form can transform into a malignant tumor.

Seeing photos of glossitis of different etiologies, you can be sure that the clinical symptoms of this disease are diverse, so only a specialist can make a differential diagnosis.

Glossitis of the tongue can be either an independent disease or one of the clinical symptoms of another pathology. For proper treatment, it is necessary to find out whether the disease is a primary inflammatory process, or has arisen as a result of changes in other organs and systems.

Causes of glossitis

Glossitis occurs under the influence of provoking factors. The most common of these is damage to the mucosa. Damage can occur due to the use of solid foods, spicy, hot. Often the tongue is injured by crowns, fragments of teeth, braces or improperly made removable dentures. For the penetration of infection, a microscopic defect is sufficient, which does not cause discomfort and is visually invisible.

Infection in the oral cavity increases the likelihood of inflammation in trauma. These include carious teeth, inflammation of the gums, stomatitis, chronic tonsillitis. Non-compliance with hygiene rules, the use of someone else’s dishes, a toothbrush, dirty hands while eating increase the risk of infection entering the oral cavity. In a special risk group are children who can take dirty hands and third-party objects into their mouths.

Smoking and alcohol reduce local immunity, make the mucous membrane more vulnerable. Glossitis is more common in this group of patients than in other people.

Chronic exposure to mucosal destroying chemicals leads to chronic inflammation over time. The cause of glossitis can be even poor-quality toothpaste or mouthwash.

Dysbacteriosis, carriage of the herpes virus, reduced immunity are favorable factors in the occurrence of glossitis.

Clinical manifestations

The first thing that patients with glossitis face is pain, burning, severe discomfort in the oral cavity. Over time, the intensity of these manifestations increases, which makes it difficult to eat food. Taste sensations are dulled, may be completely absent. Some patients have such a phenomenon as perverse taste.

The tongue swells, causing severe discomfort. The patient’s speech is disturbed, any movement of the tongue brings pain. Possible hyperthermia, deterioration of general well-being.

Examination reveals an enlargement of the tongue, a change in its color to a brighter one up to crimson. Ulcers, vesicles, spots, erosions, plaque, foci with a changed structure of the epithelium may appear on the mucosa.

The most formidable complication of glossitis is phlegmon. A focus of purulent inflammation is formed, which rapidly spreads to the chin and neck. Soft tissues are destroyed. These patients need urgent medical attention.

Diagnosis and treatment of glossitis

In most cases, the diagnosis is based on the patient’s complaints and visual examination of the oral cavity.

When visiting a doctor, be sure to indicate when the pathological manifestations appeared, what they are associated with. If you have had any dental treatment, be sure to mention it. It is better to seek medical help at the first sign of illness. Avoid taking any medications, especially antibiotics. This can complicate diagnosis and reduce the effectiveness of subsequent therapy.

To determine the cause of glossitis, additional diagnostic methods are used: examination of scrapings from the mucous membrane under a microscope, ELISA, PCR. These methods allow you to establish which pathogen caused the disease, as well as to confirm or exclude syphilitic glossitis.

Identification of the causative agent is the basis for successful treatment. The emphasis is on etiotropic therapy, that is, the elimination of the cause of the disease. If glossitis is of a bacterial nature, properly selected antibiotics will give an excellent result, but these drugs are completely useless for viral or candidal glossitis. In case of fungal infection, antimycotic drugs are prescribed, in case of viral infection, antiviral and immunomodulators are prescribed. If the cause of glossitis is anemia, treatment of the underlying disease is necessary. Special tactics are necessary for the pathological process caused by pale treponema. A dermatovenereologist is necessarily connected to the treatment of syphilitic glossitis.

Diet is an integral part of glossitis treatment. In the acute period, food intake causes serious difficulties for patients, therefore cereals, mashed potatoes, pureed soups are recommended. Food should not be cold or hot. Excluded solid foods, spicy, salty, sour. This avoids irritation of the mucous membrane, which minimizes discomfort and speeds up the healing process.

In some patients, the pain syndrome is pronounced. In such a situation, discomfort can be removed with the help of applications with anesthetics. To moisturize excessively dry mucous membranes, products containing glycerin are used.

Local therapy includes removal of plaque from the tongue and treatment with antiseptic solutions. Substances such as chlorhexidine, furatsilin, potassium permanganate are widely used. To accelerate the recovery of the mucosa, vitamin A is applied topically.

Systemic antibiotics and antiviral drugs are prescribed according to indications. This tactic is used in severe cases. With a mild clinical course of glossitis, a positive result can be achieved with the help of local treatment.

In severe cases, swelling of the tongue can be significant and make breathing difficult. In such situations, it is necessary to take glucocorticosteroids. Most often they are used in the form of ointments.

Smoking and alcohol should be avoided during treatment. These substances irritate the mucous membrane and prevent its regeneration.

Some patients with glossitis have keratinized areas on the tongue. Such changes are not amenable to conservative treatment and are removed only by surgery.

If you consult a dentist in a timely manner and follow all his recommendations, then the outcome of the disease will be favorable. Glossitis responds well to treatment if its cause is established and targeted to act on it. If the disease is not treated, it can be complicated by an abscess or phlegmon. These conditions require surgical treatment and long-term antibiotic therapy, so it is best to start treatment at an early stage.

Prevention

Glossitis is easier to prevent than to treat. In order to avoid this unpleasant disease, you need to follow simple rules.

The first is oral hygiene. This principle applies to both children and adults. If you wash your hands before eating, brush your teeth regularly, do not use other people’s toothbrushes and carry out sanitation of the oral cavity in a timely manner, then the risk of developing inflammation of the tongue is minimal.

Avoid mucosal damage. Avoid hard foods that can damage your tongue, such as chips. Hot foods also cause epithelial defects. Spicy foods have an irritating effect. Abuse of them significantly worsens the condition of the mucous membrane of the tongue and increases the risk of infection.

Nicotine not only irritates the mucosa, but also impairs microcirculation, which reduces the resistance of the epithelium to the effects of infectious agents. Inflammatory diseases of the oral cavity in smokers are more common than in non-smokers. Negatively affect the mucous membrane and strong alcoholic drinks.

If you have symptoms of glossitis, do not self-medicate, go to a dental clinic. A competent specialist will establish the cause of the disease and prescribe a treatment that will help to quickly get rid of unpleasant manifestations.