Lingual Abscess: Predisposing Factors, Pathophysiology, Clinical Manifestations, Diagnosis, and Management

Abstract

Lingual abscess is a rare disorder, and current knowledge regarding clinical manifestations and treatment modalities has not been well established. This study presented 6 cases of lingual abscess patients between January 2012 and December 2017. There were three men and three women. Median age was 54 years. Odynophagia and local pain were the common presenting symptoms. Local trauma was the main predisposing factor of anterior abscess, while lingual tonsillitis or infected thyroglossal cyst was the predisposing factor of posterior abscess. An impending airway obstruction was identified in two patients, requiring tracheostomy. All patients achieved an excellent outcome with a combination of surgical drainage and proper antibiotics as well as using proper investigation for detecting unusual areas of lingual abscess. According to the data from the study's results and review of the relevant literature, an abscess located at the anterior two-thirds of the tongue is easy to diagnose while the posterior one-third of the tongue abscess is relative difficulty. Using contrast-enhanced computed tomography increases diagnostic accuracy, especially on the tongue base and deep space infection. The management strategies include (1) protecting the airway, (2) draining the abscess by needle aspiration or surgery, and (3) administering antibiotics early. Our series showed a superiority of surgical drainage when the patients present with marked tissue edema, deep loculated infection, and airway obstruction.

Lingual Abscess in a Young, Healthy Woman Patient

“…6 Although the literature information consists of case reports, it provides adequate information for treatment. [3][4][5] Owing to rich vascularization and lymphatic drainage, stratified mucosa, immunological protective properties of saliva, they all are protective against infectious processes. 5,7,8…”

“…The most important factors related to the tongue abscess are poor oral hygiene, recurrent trauma, iatrogenic trauma, immunocompromising illnesses, and foreign bodies. 4 A posteriorly localized abscess can be secondary to thyroglossal ductus cyst, lingual tonsillitis, or periodontal infections. 6,[9][10][11] However, it can occur without any known risk factor like in the case we presented.…”

“…Especially patients with posteriorly localized abscesses should be screened carefully to avoid urgent tracheotomy procedure. 4 As known, an urgent tracheotomy has more complication rates than an elective procedure. As anteriorly localized abscesses can be drained with a needle, laterally localized ones can be drained by incision and drainage procedure, and posteriorly localized ab-scesses can be drained by needle or open procedure.…”

“…By means of suitable treatments, mortality occurs in less than 3% of cases. 4 In the differential diagnosis, epiglottitis, angioedema, neoplasm, cystic lesions and tuberculosis should be considered. 3 In conclusion, patients with pain, tenderness, odynophagia, dysphagia, and the respiratory problem should be screened carefully for potential mortal tongue abscesses and in any suspicion, an MRI or CT with contrast should be performed to avoid any misdiagnose or delay.…”

Lingual tonsil abscess: a rare, life-threatening cause of acute sore throat

“…Airway protection is the first priority, and a low threshold for awake intubation or surgical tracheostomy is essential. In the most comprehensive review of the literature to date, Srivanitchapoom report 18 cases,1 all of which underwent surgical procedures ranging from simple aspiration to incision and drainage, with two cases requiring tracheostomy. Our case is unique in that it is the only reported instance in the literature of medical management alone.…”