Case report: Traumatic lingual hematoma

Abstract

We describe a case of traumatic lingual hematoma in a patient on dual antiplatelet therapy. After securing the airway, bilateral lingual artery embolization successfully halted expanding hematoma formation. Patient subsequently required tracheostomy for continued airway edema. Although patient course was wrought with postoperative complications, we review this case to illustrate how prompt hematoma evacuation and embolization can resolve significant vasovagal bradycardia and hypotension secondary to expansile lingual hematoma.

Life-Threatening Sublingual Hematoma in the Setting of Anticoagulation and Neck Trauma

“…The anatomic position of the tongue predisposes a posterior-cephalad displacement upon sublingual hematoma formation, which may result in lethal upper airway obstruction [ 1 , 2 ]. In non-emergent cases, flexible fiberoptic laryngoscopy has been utilized to assess the degree of obstruction, which may prevent unnecessary intubations [ 3 ]. In the setting of lingual trauma, close monitoring for developing signs of respiratory distress and upper airway obstruction, such as swelling, bleeding, dysphonia, drooling, dyspnea, and stridor, is vital for prompt airway protection [ 2 - 3 ].…”

“…Enlargement of the tongue due to sublingual hematoma resulting from neck trauma can lead to life-threatening upper airway emergencies [ 1 - 2 ]. The rich vascularity of the tongue leaves it susceptible to rapid hemorrhage after trauma or vascular insult [ 2 - 3 ]. This outflow of blood can result in massive tongue enlargement with cephalad and posterior displacement and subsequent lethal upper airway obstruction [ 2 ].…”

“…Primary etiologies of lingual hematoma include oropharyngeal trauma, such as motor vehicle accidents, seizures, and traumatic intubations, as well as spontaneous causes, such as hypertension and vascular malformation in the lingual arterial system. These etiologies are often mediated by the use of anticoagulation therapy and coagulopathic states, such as renal and liver failure [ 1 - 3 ].…”

Point-of-care ultrasound in lingual hematoma

“…Acute tongue enlargement is a rare but recognized airway hazard resulting from trauma, vascular anomalies, or coagulopathy and also due to edema, infarction, and infection. [ 1 2 ] Tongue hematoma which develops post trauma can be due to road traffic accident,[ 3 ] dental surgery,[ 4 ] and tongue bite during seizure. [ 5 ] Tongue is a vascular structure supplied by the branches of lingual artery, which can result in significant bleeding and hematoma formation.…”

Maxillofacial and Oral Aspects of Dysphagia

“…This most commonly entails extra-oral ligation of the lingual artery and which requires a detailed understanding of the involved anatomy. Being able to recognize the initial presentation, underlying cause and relevant anatomy of lingual hematomas is critical to the proper management and treatment of this condition [75].…”