Sulbactam

INTRODUCTION: Tongue bites and lacerations are well-recognized complications of seizure disorder. Because of the rich vascular supply, most tongue lacerations heal rapidly without interventions. Only tongue lacerations in which poor healing may compromise tongue function require more aggressive treatment. We present a case, in which the tongue injury led to severe complications, including sepsis.

CASE PRESENTATION: An otherwise healthy 23-year old male with severe mental retardation, autism and seizure disorder was brought to emergency department for evaluation of severe bleeding from a swollen tongue. According to patient's mother, he had a seizures 5 days prior and was seen in outside facility with significant bleeding from tongue bite. By the time of initial evaluation bleeding stopped and patient was discharged. Over next few day patient became progressively more combative with increasing tongue swelling, intermittent bleeding and became unable to swallow pills or food. Mother noted him spitting out pieces of bloody tissue. In emergency department patient was intubated for combative behavior and airway protection. Hypotension required fluid resuscitation and vasopressors. A foul smell was noted as the examination revealed a necrotic tongue. Patient was evaluated by the otolaryngology service and taken to operating room for debridement. Tissue cultures and blood cultures grew positive for Beta Streptococcus group B. Patient was treated with ceftriaxone and clindamycin for 6 days andthen was switched to ampicillin-sulbactam in accordance with culture and sensitivity report. Patient recovered with the assistance of speech therapy and was discharged to his group home in stable condition.

DISCUSSIONS: The tongue is very vascular organ that usually tolerated a great degree of trauma. Most injuries heal well. Because the tongue plays such a major role in speech and swallowing, surgical resection is usually withheld until other options are exhausted. The recognition of the severity of our patient's self-inflicted injury was delayed. . Not until the necrosis led to infection and sepsis did the seriousness of the trauma became undeniably obvious.

CONCLUSION: Even though complications from tongue lacerations are rare due to very rich vasculature in the tongue, this ease clearly demonstrate that the possibility of serious infection and sepsis can occur.

REFERENCES:

(1) Lamell, CW, Fraone, G, Casamassima, PS, Wilson, S. Presenting characteristics and treatment outcomes for tongue laceration in children, Pediatr Dent 1999; 21:34

(2) Barley, BJ. Management of soft tissue injuries. In: Oral and Maxillofascial Traum

DISCLOSURE: Marina Dolina, None.

Marina Dolina MD * Janette D. Foster MD Jon Isaacson MD Francis Ruggiero MB, BCh Margaret Wojnar MD Pennsylvania State University College of Medicine, Hershey, PA

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group