Abstract
Background
Lingual hematoma (LH) is a relatively uncommon entity seen after both medical and
traumatic etiologies. Regardless of the cause, the feared complication is acute airway
obstruction.
Case Report
Our case involves a 39-year-old man who presented to the Emergency Department via
emergency medical services with an enlarging LH after an unwitnessed fall, suspected
to be an alcohol withdrawal seizure. The bleeding was likely exacerbated by previously
undiagnosed thrombocytopenia. Airway stabilization was rapidly established via nasotracheal
intubation after standard intubation techniques were deemed unfeasible. Despite correction
of the coagulopathy, the LH continued to expand, resulting in bilateral tympanomandibular
joint (TMJ) dislocations. To our knowledge, this complication has not been previously
reported as a complication of LH.
Why Should an Emergency Physician Be Aware of This?
Despite being a relatively uncommon condition, LH has the potential to result in life-threatening
airway obstruction with limited airway options. Prompt airway stabilization should
be the first priority upon diagnosis. A rapidly evolving LH can limit standard orotracheal
rapid sequence intubation options, and may require alternative airway procedures.
Additionally, ongoing lingual swelling after airway stabilization has now been shown
in our case to result in bilateral TMJ dislocations. Concurrent management of reversible
coagulopathy may help prevent this complication or reduce its severity.
Keywords
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References
- Diagnosis and management of upper airway obstruction due to lingual hematoma: report of a case.J Oral Maxillofac Surg. 2011; 69: 558-563
- Upper airway obstruction induced by warfarin sodium.Arch Otolaryngol. 1976; 102: 505-506
- Nasal intubation: a comprehensive review.Indian J Crit Care Med. 2016; 20: 662-667
Article info
Publication history
Published online: February 13, 2018
Accepted:
December 26,
2017
Received in revised form:
December 18,
2017
Received:
October 10,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
