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East and Central African Journal of Surgery
Association of Surgeons of East Africa and College of Surgeons of East Central and Southern Africa
ISSN: 1024-297X EISSN: 2073-9990
Vol. 15, Num. 2, 2010, pp. 136-139

East and Central African Journal of Surgery, Vol. 15, No. 2, July-December, 2010, pp. 136-139

Case Report

Tongue Entrapment in an Aluminium Milk Can: An Unusual Cause of Tongue Injury

1 Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex (O.A.U.T.H.C), Ile-Ife, Osun State, Nigeria
2 Paediatric Emergency Unit, Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex (O.A.U.T.H.C), Ile-Ife, Osun State, Nigeria

Correspondence Address:J A Eziyi, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex (O.A.U.T.H.C), Ile-Ife, Osun State,Nigeria ,eni_adeyemo@yahoo.com

Code Number: js10049

Abstract

Peri-oral injuries are common findings in paediatric patients; however, tongue injury following entrapment in bottles and cans is rare and has not been reported in our locality. A case of a 9- year old previously healthy female child who got her tongue tightly entrapped in an half opened aluminium milk can while in school is hereby presented. This case highlights the result of careless and often dangerous play and misadventures of children and the challenge of management. It calls for vigilance and close supervision of children by caregivers at home and at school. Early presentation, immediate intervention and treatment can prevent grave consequences.

Introduction

Peri oral injuries are common findings in paediatric patients, and they may have significant medical, dental and psychological consequences in the affected children [1] . In the USA, the tongue is the second most common site of oral mucosal lesion in children and youths after the lip and this is commonly due to bites, followed by stomatitis, herpes labialis and geographic tongue [2] . In Nigeria however, the tongue is the most common reported site of oral mucosal lesion and this is most commonly due to fall followed by road traffic accident [3] .

Tongue injury may also result during convulsions in children with epilepsy, intense oro - facial spasms in Leigh diseases [4] , forceful insertion of spoon into the mouth of children with febrile convulsion [5] and from baby walker injury [6] . A complete tongue amputation during a fight had been reported [7] . It is seen more commonly in boys than girls [2],[3] within the age range of 3 months to 17years with the highest occurrence in the 0-5 years old [2],[3] . These may be due to the fact that children are more restless, exploitative and adventurous [8] , and are constantly exploring [9] . Most tongue injuries are minor injuries that can be managed conservatively [3] . There are few report of tongue injury from tongue entrapment in bottles [10],[11] and can [12] from the western world but we are not aware of any such report from the tropics.

We are reporting the case of a 9-year old Nigerian girl who had tongue entrapment in an old half opened condensed milk can while trying to lick ′garri′ and sugar contained in the can.

Case Report:

O. J , a 9-year old Nigerian girl presented to the paediatric emergency unit of our hospital with history of tongue entrapment in an old aluminium milk can 20 minutes before presentation while licking garri (A staple Nigerian food) and sugar contained in it while at school. There was associated pain, drooling of saliva and minimal blood loss. There was no difficulty in breathing. There was neither a previous history of similar incidence nor history suggestive of mental derangements. She had no history of previous hospital admission, surgery or blood transfusion. She was the only child of deceased parents, and lives with her maternal grandmother. Review of systems revealed no abnormality.

Examination showed a healthy school girl in obvious painful distress, sweating profusely and drooling saliva. Vital signs were within normal limits. The anterior 1/3 of the tongue was trapped in a half opened milk can [Figure - 1]. It was massively edematous and cyanotic. There was minimal bleeding. The ear, nose, oro-pharynx and other systems were essentially normal.

The tongue release was done under sedation with intravenous diazepam in the emergency paediatric department, using a strong Mayo′s scissors to cut open the can. Fragments of the can were removed and the oral cavity copiously irrigated with normal saline [Figure - 2].

Post procedure findings were minimal abrasions on the dorsum tongue at the junction of the anterior and middle one-third. The anterior one-third of the tongue was massively edematous. This however returned to normal size within one and a half hour [Figure - 3] which began to resolve quickly. She was given 750 i.u of anti-tetanus serum after a test dose, 0.5ml of tetanus toxoid, amoxicillin- clavulanic acid antibiotics, analgesic and regular warm salt water gargle.

She was subsequently discharged the same day to the ear, nose and throat clinic for follow up in the outpatient clinic after several hours of observation but was lost to follow up.

Discussion

Injury commonly occur in children due to the fact that they are more restless, exploitative and adventurous and are constantly exploring [8],[9] . These injuries commonly follows falls from heights, febrile convulsions, burns and electrical injuries, drowning and near drowning and usually affect major body parts [3],[5],[13] and occasionally the tongue. Tongue injury due to entrapment had been reported as isolated cases mainly in the United State of America [10],[11],[12] . This 9 year old girl presented with tongue entrapment in an-old half opened milk can while trying to lick garri (a powdered Nigerian staple cassava food) contained in it while at school.

In injury to the tongue, the most common location is the dorsum of the anterior 1/3 [2],[14] . This is also the site in this index case. The age of our patient is also within the commonly affected age group involved in oro- facial tissue injury [2],[3] . The tongue on presentation was massively edematous because of impaired venous return due to constriction by the edge of the half opened can. After removal of the can and copious irrigation, the edema resolved within one and a half hour [Figure - 3]. The challenge in the management of this case is that metal cutting facilities are not part of the regular surgical armamentarium and repeated attempts were made with different instruments to cut open the can. This type of problem is well illustrated in a tongue entrapped in a bottle in which a professional glazier was involved in the management [11] . This may lead to delay in the intervention unless an alternative is readily available. Early presentation and immediate intervention are important. This was the case of this patient who presented within 30 minutes of the incidence and this prevented the complications that could follow prolonged entrapment which include ecchymosis, lingual edema, ischaemia, gangrene and auto amputation [7],[10],[15] .

Conclusion

Tongue entrapment though rare, is a cause of peri-oral injury which is preventable [1] but not without grave consequences. However, early presentation, immediate intervention and treatment can prevent these. This case highlights the result of careless and often dangerous play and misadventures of children and the challenge of management. It calls for vigilance and close supervision of children by caregivers at home and at school.

References

1.Rothman DL. Pediatric orofacial injuries. J Calif Dent Assoc. 1996; 24(3): 37-42.   Back to cited text no. 1    
2.Shulman JD. Prevalence of oral mucosal lesions in children and youths in the USA. Int J Paediatr Dent. 2005; 15(2): 89-97.   Back to cited text no. 2    
3.Bankole OO, Fasola AO, Denloye OO. Oro-facial soft tissue injuries in Nigerian children: a five-year review. Afr J Med Med Sci. 2004; 33(2): 93-7.   Back to cited text no. 3    
4.Diab M. Self-inflicted orodental injury in a child with Leigh disease. Int J Paediatr Dent. 2004; 14(1): 73-7.   Back to cited text no. 4    
5.Ndukwe KC, Folayan MO, Ugboko VI, Elusiyan JB, Laja OO Orofacial injuries associated with prehospital management of febrile convulsion in Nigerian children. Dent Traumatol. 2007; 23(2): 72-5.   Back to cited text no. 5    
6.Al-Nouri L, Al-Isami S. Baby walker injuries. Ann Trop Paediatr. 2006; 26(1): 67-71.   Back to cited text no. 6    
7.Toure S, Fall I, Diallo BK, Diouf R, Sane JC, Diouf M, Neissem B, Diop R, Diop EH [Emergency reimplantation of the tongue after complete traumatic amputation]. Rev Stomatol Chir Maxillofac. 2003; 104(1): 52-4.   Back to cited text no. 7    
8.Lather M, Borchard S, St-vil D, et al. Falls from heights among children: A retrospective review. J. Paediatric Surg 1999; 34: 1060-3.   Back to cited text no. 8    
9.Broz L, Kripner J, Brucek S. Emergency care of severe burn children (an experience of Pragua burn center). Acta Chir Plas 1995; 37: 89-93.  Back to cited text no. 9    
10.Green DC. Bottleneck entrapment of the tongue. Otolaryngol Head Neck Surg. 1995; 113(4): 508-9.   Back to cited text no. 10    
11.Guha SJ, Catz ND Lingual ischemia following tongue entrapment in a glass bottle. J Emerg Med. 1997; 15(5): 637-8.  Back to cited text no. 11    
12.Bank DE, Diaz L, Behrman DA, Delaney J, Bizzocco S. Tongue entrapment in an aluminum juice can. Pediatr Emerg Care. 2004; 20(4): 242-3.  Back to cited text no. 12    
13.ShimoyamaT, Kaneko T, Nasu D, Suzuki T, Horie N. A case of an electrical burn in the oral cavity of an adult. J Oral Sci. 1999; 41(3): 127-8.  Back to cited text no. 13    
14.Lamell CW, Fraone G, Casamassimo PS, Wilson S. Presenting characteristics and treatment outcomes for tongue lacerations in children. Pediatr Dent. 1999; 21(1): 34-8.   Back to cited text no. 14    
15.Singh K. Partial glossectomy for lingual edema following injury. Indian Pediatr. 2004; 41(5): 520.  Back to cited text no. 15    

Copyright 2010 - East and Central African Journal of Surgery


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