Tongue abscess is a local purulent-necrotic inflammation characterized by the formation of an abscess surrounded by an infiltrative capsule in the thickness of the tongue. Tongue abscess manifests itself as malaise, an increase in body temperature, painful swelling of the tongue, difficulty talking, eating and even breathing. Pathology is diagnosed on the basis of the signs revealed during the examination, puncture and microbiological examination of the contents of the abscess. Treatment of the formed abscess of the tongue includes its surgical opening, rinsing of the oral cavity with antiseptic solutions, systemic therapy with antibacterial and anti-inflammatory drugs, taking vitamins.
Tongue abscess is a local inflammatory focus in the tissues of the tongue, which is a cavity with purulent exudate, limited by a pyogenic membrane. Tongue abscess is one of the diseases that are quite common in surgical dentistry. In most cases, the occurrence of an abscess is associated with the penetration of pathogenic microflora through the damaged tissues of the tongue.
Abscess is one of the most dangerous purulent-inflammatory diseases of the oral cavity, especially in the case of its localization in the area of the root of the tongue. In the absence of adequate and timely treatment, disease can lead to severe complications: phlegmonous glossitis, neck phlegmon and the development of mediastinitis, fraught with death. Therefore, it is extremely important to urgently contact a specialist when the first symptoms of a tongue abscess appear.
Causes of tongue abscess
The direct cause of the development of a tongue abscess is a bacterial infection, the etiological agents are usually staphylococci, streptococci and anaerobic flora. The entrance gates for bacteria are usually wounds resulting from various injuries: damage to the mucous membrane of the tongue by fish bones, sharp edges of teeth, incorrectly made dentures, etc.
It is possible to develop tongue abscess due to the transition of inflammation from the lower front teeth, for example, with purulent periodontitis. Abscess of the tongue can be a complication of glossitis, ulcerative stomatitis, sometimes acute tonsillitis. In addition, an abscess can be caused by the penetration of infection through the ungrown blind (morganian) opening of the tongue.
Anatomical features of the structure of the tongue play an important role in the course of inflammatory processes in its various departments. There are no significant layers of connective tissue between the longitudinal, transverse and vertical muscle bundles of the upper part of the tongue. The dense fibrous septum that separates the muscle groups of the left and right half of the tongue is to a certain extent an obstacle to the spread of inflammation. Therefore, an abscess that has arisen on one side of the tongue rarely passes beyond the middle line to the other side.
In the spaces between the deep-lying muscles of the tongue (chin-lingual, awl-lingual and sublingual) there are quite significant amounts of fiber and lymph nodes are located. The tongue abscess localized in this area is very dangerous and is fraught with the spread of the purulent-inflammatory process to the nearby tissues of the neck and mediastinum.
Symptoms of tongue abscess
Pathology, as a rule, develops very quickly. By localization, superficial and deep abscesses are distinguished. A superficial abscess is located directly under the mucous membrane, most often on the back of the tongue. When swallowing and tongue movements, the patient experiences sharp pain, which can sometimes give in the ear. Visually, an edematous area of the hyperemic mucosa is detected, a painful seal is felt during palpation. Superficial abscesses of the tongue are sometimes opened independently, after which the condition is relieved. Nevertheless, in order to avoid complications, you should definitely see a specialist.
A deep abscess is localized in the thickness of the tissues of the tongue. This form of pathology is characterized by a general deterioration of well-being: weakness, malaise, sleep and appetite disorders, headache, tachycardia, fever up to 38-40 ° C, sometimes with chills. There is an increase in submandibular and submandibular lymph nodes, excessive salivation, swelling and soreness of the tongue. Its mucous membrane acquires a bluish color, is covered with a dirty gray coating; a putrid smell is felt from the oral cavity.
The tongue increases significantly in volume, sometimes to such an extent that it does not fit in the mouth, especially if the abscess is localized in the root of the tongue. Because of this, speech becomes slurred, breathing becomes difficult, which causes the patient excitement and a feeling of fear. In addition, the patient retains a forced sitting position of the body. Palpation reveals the presence of a dense painful infiltrate; in the case of unclear fluctuation, a puncture is used to detect the abscess. If recurrent abscesses are observed in the center of the tongue, then this is a sign of non-infection of the blind hole.
Tongue abscess is diagnosed by a dentist on the basis of anamnesis, identified clinical manifestations and necessary laboratory tests. According to the results of a general blood test, signs of the inflammatory process are determined – an increase in ESR and leukocytosis. To determine the pathogens, microbiological seeding of the separated abscess is performed.
X-ray examination is informative for differential diagnosis, clarification of the odontogenic source of infection and detection of complications. Disease must be differentiated from diseases similar in symptoms, such as phlegmon of the bottom of the oral cavity (Ludwig’s angina), abscessing lymphadenitis of the subcutaneous lymph nodes and other pathologies.
Treatment of tongue abscess
Treatment of a superficial abscess of the tongue begins with conservative measures: rinsing the oral cavity with antiseptic solutions, for example, chlorhexidine or nitrofural, taking antibacterial drugs. These measures in many cases make it possible to avoid surgery, however, if conservative therapy does not succeed, they resort to surgery.
Treatment of a deep abscess of the tongue is carried out exclusively surgically. To prevent further spread of infection, the dentist-surgeon opens the purulent cavity with a longitudinal incision. In the case of localization of the abscess at the root of the tongue, an autopsy can be performed from the skin under the chin.
When dissecting the wall of the abscess, there is usually an outpouring of pus under high pressure, and the patient almost immediately feels relief from breathing and swallowing. After that, the abscess cavity is washed with a solution of proteolytic enzymes with antibiotics, and then the wound is drained to ensure the outflow of purulent exudate.
With an increase in the symptom of difficulty breathing, a tracheotomy is performed. In addition to surgical treatment, therapy with antibiotics, antihistamines and anti-inflammatory drugs, multivitamins and frequent irrigation of the oral cavity with antiseptics, including solutions of soda or potassium permanganate, is prescribed. Rinsing is also carried out with warm decoctions of medicinal plants – chamomile and sage. In addition, the use of UHF therapy is recommended in complex treatment.
Prognosis and prevention
The success of the treatment of purulent-inflammatory diseases largely depends on the time of treatment to a specialist and the general health of the patient. If therapeutic measures for tongue abscess are started in a timely manner, the prognosis is favorable – the disease is cured within 14 days. With significant neglect of pathology, severe complications may develop, including phlegmon, mediastinitis and sepsis. In such cases, the prognosis is unfavorable, even a fatal outcome is possible.