دانلود رایگان مقاله انگلیسی دررفتگی مفصل تمپورال فک پایین ناشی از هماتوم ترومایی لینگوال - الزویر 2018

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.

DISCUSSION

Traumatic LH is a rare condition, with airway obstruction being the feared complication. Resolution of glossomegaly can take days. Most reports of LH result from thrombolytics, anticoagulants, or hemophilia, and are of a spontaneous nature. Fewer reports discuss LH resulting from trauma (1). Traumatic cases have been associated with seizures and other types of oral-facial trauma or instrumentation such as dental procedures. To our knowledge, there are no reported cases of LH resulting in bilateral TMJ dislocation.

The tongue is an extremely vascular structure comprised of both intrinsic and extrinsic muscles and supplied by branches of the lingual artery, off the external carotid artery. LH resulting in severe airway compromise is rare, but airway management should always be first priority. If the LH rapidly enlarges, it can impede the airway as it continues to displace the tongue both superiorly and posteriorly. Less commonly, bleeding can originate in or spread to the sublingual and submandibular spaces.