An unusual foreign body (tooth) in the tongue By R. N. SRIVASTAVA*. D. V. DuAf and AMRESH KUMARJ (Kanpur, India) Introduction bodies in the tongue are rare. Khan and Hua (1968) reported a single case of foreign body (safety pin) in the genioglossus muscle of a 2 years and 9month-old child. Here we are reporting an unusual case of foreign body in the tongue in an adult. Case report G., a 45-year-old Mohammedan lady, attended the E.N.T. Out Patient Department of L.L.R. Hospital, Kanpur on 7.2.1976. with the following complaints: FOREIGN
Swelling on the left side of the dorsum of tongue near the tip Pain in the swollen area during deglutition Purulent discharge from the swelling off and on
5 months. 5 months. 2 months.
History of present illness The patient was all right until about 5 months before she was seen. She had a gun-shot injury over the face while she was sleeping. After injury, she noticed a generalized swelling of the tongue for which she took some medical treatment with only partial relief and the swelling on the left side of the dorsum of the tongue persisted. On examination There was a healed oval scar of about J" in size over the left side of the face, 1" anterior to the angle of the mandible. Examination of the tongue showed a swelling which was rounded in shape, about 2 cms. x 1 cm. in diameter, red in colour, non-pulsatile and situated on the left side of the dorsum of the tongue near the tip. On palpation the swelling was firm in consistency, tender and non-ulcerated with ill-defined margins; the surface over the swelling was irregular. The teeth were dirty, the first lower molar was absent on left side and there was no history of dental extraction. A tentative diagnosis of an inflammatory swelling of the tongue was made. The patient was kept on antibiotics and advised to attend O.P.D. after 7 days. She again attended the E.N.T. O.P.D. without any relief in the local lesion. In view of her past history of injury to the face, the firmness of the swelling and the absence of the lower molar (left) without any history of tooth extraction, we considered the possibility that she might have a foreign body granuloma of the tongue and she was advised exploration under general anaesthesia for which she was admitted on 14.2.76. •Lecturer, Department of E.N.T., GSVM Medical College, Kanpur. f Lecturer, Department of Anaesthesiology, GSVM Medical College, Kanpur. ^Postgraduate, Department of E.N.T., GSVM Medical College, Kanpur.
263
R. N. Srivastava, D. V. Dua and Amresh Kumar
FIG. I .
X-ray showing impacted tooth in the tongue.
30'
FIG. 2. Showing carious tooth after removal.
264
Clinical records Investigations
Blood and urine examinations were within normal limits. A soft-tissue X-ray of the tongue was taken, and this showed a radio-opaque shadow the shape of tooth (Fig. i). Operation
The patient was operated upon under general anaesthesia with nasotracheal intubation, and the oropharynx was packed with a gauze pack. After opening the mouth with the help of a mouth gauge, the swelling over the tongue was seen. A longitudinal incision about 2 cms. long was made on the lateral margin of the swelling and the tongue tissues were dissected. A tooth was found embedded in the substance of the tongue. It was removed and it was seen to be carious (Fig. 2). The wound was stitched with catgut. Postoperatively she was kept under cover of antibiotics and steroids. Feeding was maintained by Ryle's tube as she developed reactionary oedema of the tongue during the postoperative phase. The Ryle's tube was removed on the 3rd day after the operation and she was discharged on 5.3.76. without any complication. Summary
This unusual foreign body in the tongue of a 45-year-old lady must be unique. The most interesting feature of the present case was that the patient had sustained a gun-shot injury about five months earlier leading to traumatic extraction of the first left lower molar tooth and its impaction into the tongue. The patient herself was not aware of it and she attended the hospital complaining only of a simple swelling of tongue. Acknowledgement
The authors are very thankful to the Superintendent, L.L.R. Hospital, Kanpur for his kind permission to publish the case record. A. AFZAL, and 82, 153
KHAN,
REFERENCE (1968) Journal of Laryngology and Otology,
HUA, MOMINUL
Dr. R. N. Srivastava, M.S., D-I2, Medical College Campus, Kanpur-208002 (U.P.), India.
265
Swelling on the left side of the dorsum of tongue near the tip Pain in the swollen area during deglutition Purulent discharge from the swelling off and on
5 months. 5 months. 2 months.
History of present illness The patient was all right until about 5 months before she was seen. She had a gun-shot injury over the face while she was sleeping. After injury, she noticed a generalized swelling of the tongue for which she took some medical treatment with only partial relief and the swelling on the left side of the dorsum of the tongue persisted. On examination There was a healed oval scar of about J" in size over the left side of the face, 1" anterior to the angle of the mandible. Examination of the tongue showed a swelling which was rounded in shape, about 2 cms. x 1 cm. in diameter, red in colour, non-pulsatile and situated on the left side of the dorsum of the tongue near the tip. On palpation the swelling was firm in consistency, tender and non-ulcerated with ill-defined margins; the surface over the swelling was irregular. The teeth were dirty, the first lower molar was absent on left side and there was no history of dental extraction. A tentative diagnosis of an inflammatory swelling of the tongue was made. The patient was kept on antibiotics and advised to attend O.P.D. after 7 days. She again attended the E.N.T. O.P.D. without any relief in the local lesion. In view of her past history of injury to the face, the firmness of the swelling and the absence of the lower molar (left) without any history of tooth extraction, we considered the possibility that she might have a foreign body granuloma of the tongue and she was advised exploration under general anaesthesia for which she was admitted on 14.2.76. •Lecturer, Department of E.N.T., GSVM Medical College, Kanpur. f Lecturer, Department of Anaesthesiology, GSVM Medical College, Kanpur. ^Postgraduate, Department of E.N.T., GSVM Medical College, Kanpur.
263
R. N. Srivastava, D. V. Dua and Amresh Kumar
FIG. I .
X-ray showing impacted tooth in the tongue.
30'
FIG. 2. Showing carious tooth after removal.
264
Clinical records Investigations
Blood and urine examinations were within normal limits. A soft-tissue X-ray of the tongue was taken, and this showed a radio-opaque shadow the shape of tooth (Fig. i). Operation
The patient was operated upon under general anaesthesia with nasotracheal intubation, and the oropharynx was packed with a gauze pack. After opening the mouth with the help of a mouth gauge, the swelling over the tongue was seen. A longitudinal incision about 2 cms. long was made on the lateral margin of the swelling and the tongue tissues were dissected. A tooth was found embedded in the substance of the tongue. It was removed and it was seen to be carious (Fig. 2). The wound was stitched with catgut. Postoperatively she was kept under cover of antibiotics and steroids. Feeding was maintained by Ryle's tube as she developed reactionary oedema of the tongue during the postoperative phase. The Ryle's tube was removed on the 3rd day after the operation and she was discharged on 5.3.76. without any complication. Summary
This unusual foreign body in the tongue of a 45-year-old lady must be unique. The most interesting feature of the present case was that the patient had sustained a gun-shot injury about five months earlier leading to traumatic extraction of the first left lower molar tooth and its impaction into the tongue. The patient herself was not aware of it and she attended the hospital complaining only of a simple swelling of tongue. Acknowledgement
The authors are very thankful to the Superintendent, L.L.R. Hospital, Kanpur for his kind permission to publish the case record. A. AFZAL, and 82, 153
KHAN,
REFERENCE (1968) Journal of Laryngology and Otology,
HUA, MOMINUL
Dr. R. N. Srivastava, M.S., D-I2, Medical College Campus, Kanpur-208002 (U.P.), India.
265
