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Eclampsia still remains an issue of serious concern in Sub Saharan Africa. Preeclampsia is the precursor to eclampsia, in which hypertension and proteinuria are present, with or without oedema1-2. This is a case of Mrs SK, a 21year old Primigravida who was unsure of her last menstrual period, but she was said to be 9 months pregnant; she developed generalized tonic clonic convulsions with each episode lasting about 30 seconds. She sustained a V-shaped laceration affecting lower one third of the tongue with clots of blood on the affected area. A diagnosis of antepartum eclampsia was made. She was admitted into the eclamptic ward and resuscitated. Intravenous infusion and Magnesium sulphate were commenced using Zuspan Regimen. She had an emergency caesarean section and was delivered of a fresh still birth female baby who weighed 3.0kg. The lacerated tongue was repaired by maxillofacial surgeon and she was transfused with 2 pints of blood. Eclampsia is the leading cause of maternal mortality in developing countries. Recognizing the features of preeclampsia and instituting appropriate measures is mandatory in order to prevent the progression of the disease to eclampsia with its associated complications.

The tongue is a muscular organ essential to a person’s ability to communicate and to experience food via taste, chewing and swallowing. Injuries to the tongue, therefore, have a considerable impact on quality of life. Tongue lacerations can result from a variety of means including seizures, self-harm, blunt force facial trauma, oral trauma while intubated, and child abuse.[1][2][3]  There have also been reported cases during electroconvulsive therapy.[4] The use of electronic cigarettes has also led to explosions causing intraoral trauma.[5] The question of which tongue lacerations require repair and which can be allowed to heal by secondary intention is still a topic of debate.[6], (Copyright © 2022, StatPearls Publishing LLC.)

Introduction: In children, tongue laceration may occur through several mechanisms, but are most common after a fall or a collision with an object or person. Tongue laceration provides a challenge for an emergency physician with a thought to suture or not. Wound closure typically involves local anaesthesia, sedative drugs, or even general anaesthesia. Objective: To describe emergencies treatment and adequate wound closure for tongue laceration in children. Case Report: Three cases of tongue laceration on the child's in the Emergency Unit, Hasan Sadikin Hospital and Padjadjaran University Dental Hospital, with complaint of bleeding from the tongue due to fall and collision with a toys. Clinical examination shows tongue laceration with different location and size. The first case was laceration of the dorsal and ventral of the tongue with 4x1 cm and 2x1x1 cm in size, wound closure and debridement were performed under general anaesthesia in the operating room. The second case was laceration of the dorsal tongue with 3x0.5x0.5 cm in size, wound closure and debridement was performed with sedative drugs and the third case was laceration of the anterior tongue with 3x1x1 cm in size, wound closure and debridement was performed in local anaesthesia. Furthermore, analgesics, antibiotic and antitetanus injection are given. Discussion: The treatment of tongue laceration should consider signs and symptoms of airway obstruction, uncontrolled bleeding, extensive tearing and cooperative levels in patients. Management of tongue laceration in children is performed wound cleansing, tongue muscle and mucosa suturing under local anaesthesia in fairly cooperative patients and with sedative drugs and general anaesthesia in uncooperative patients. Conclusion: The treatment for tongue laceration in children requires special treatment consider the level of cooperative in children and the large of the wound, which can be performed under local, sedative drugs and general anaesthesia.

Background: During spine surgeries in prone position, intraoperative neuromonitoring induced complications like oral lacerations or hematomas provoked by patient’s own bite during spinal nerve stimulations could pose management difficulties that could potentially complicate patient extubation. Methods: This study reviews in two one-year periods the incidence of occurring complications first in Group I retrospectively with standard protocols used and secondly in Group II using a proposed new management protocol with the insertion of athletes’ dental guard with preoperative size selection, awake fit-control and meticulous placement after anesthesia induction. Results: In Group I we encountered two cases with tongue lacerations, one requiring surgical intervention, while in Group II no complications were confronted. Conclusion: Even though the sample sizes are limited to indicate a significance in this study, our proposed management protocol that focuses on good preoperative planning and accurate intraoperative placement of a bite guard helped us to avoid neuromonitoring-induced oral complications of prone-position spinal surgeries.

Esophageal injuries may occur spontaneously because of iatrogenic instrumental injury, foreign body impaction, or external trauma. Traumatic esophageal laceration is rare and can lead to significant morbidity such as perforation, mediastinitis, retropharyngeal abscess, or deep neck infection. Early detection of esophageal injury improves patient outcome and survival compared with a diagnosis that is delayed by more than 24 hours after rupture. We describe the case of a 45-year-old man with esophageal laceration after facial contusion and tongue laceration. Upper airway compromise is the major concern for emergency physicians. In a nonsurgical approach, close observation is needed because there is a potential risk of progression to delayed esophageal rupture. If there is clinical deterioration, repeat endoscopy or surgical intervention should be considered. Early detection of esophageal rupture in patients with minor head injuries can reduce mortality and morbidity and avoid major surgery and, in most cases, allows the esophagus to heal normally.

Background Tongue lacerations provide a challenge for emergency physicians, especially in the case of pediatric patients. Traditional wound closure typically involves local anesthesia or procedural sedation in children, which is time consuming and often anxiety provoking for providers, patients, and parents. 2-Octyl cyanoacrylate (Dermabond®; Ethicon, Inc., Sommerville, NJ) has been used in the context of the emergency department for successful repair of lacerations, however, is not marketed for use on mucosal or intraoral surfaces. This case report describes an alternative manner of tongue laceration repair by the use of 2-octyl cyanoacrylate. Objective 2-Octyl cyanoacrylate is generally not indicated for intraoral use. Our case demonstrates a situation in which it was used safely and effectively to repair a tongue laceration. Case Report A 7-year-old boy presented to the emergency department after sustaining a large tongue laceration requiring repair. The boy's parent refused traditional wound repair with suturing due to concerns regarding the pain of local anesthesia administration, as well as risks posed by procedural sedation. The wound was repaired using the tissue adhesive 2-octyl cyanoacrylate. The patient tolerated the procedure well and there were no complications in the patient's course. Good cosmetic results were achieved using this method. Conclusions Tongue lacerations and other intraoral lacerations are challenging to repair, especially in pediatric patients. The use of tissue adhesives such as 2-octyl cyanoacrylate is very likely safe and may provide an expedient manner in which to repair such lesions with good cosmetic results.

Upper airway stimulation of the tongue using an implantable neurostimulator has recently been approved for select patients with moderate to severe obstructive sleep apnoea (OSA) and intolerance to continuous positive airway pressure therapy. Effective implantation depends on the integrity of the hypoglossal nerve as well as the tongue musculature, notably the genioglossus. Prior trauma to either of these structures may be viewed as a relative contraindication to implantation. We describe a case of successful right hypoglossal nerve implantation in a patient with a history of left cardiac pacemaker placement and severe left penetrating tongue trauma with decreased mobility from contracture and deviation mimicking a hypoglossal nerve palsy. Preoperative and postoperative apnoea-hypopnoea index values were 52/hour and 5/hour, respectively. Prior soft tissue trauma to the tongue may not necessarily preclude surgical candidacy for upper airway stimulation in patients with OSA.

Mrs G.T. presented as an unbooked grandmultipara, in eclamptic fits and severe tongue laceration complicated by intrauterine foetal death, anaemia, acute renal failure and cerebrovascular injury. A female fresh stillbirth was delivered following induction of labor at 28 weeks gestation. Tongue was observed to be gangrenous 4 days post suturing and debridement was done. Patient was discharged on the 12th day of admission with speech defect in form of slurring but was stable at follow up visit. Health professionals should be educated on the fact that loss of blood from lacerations in the mouth and tongue of an eclamptic patient can be severe enough to be a cause of morbidity as in this case and possible mortality. Recognition of such high risk cases and adequate referral should be emphasized to midwives and other health care providers in the primary care center.Madame GT grande multipare non suivie a été reçue dans un tableau d\'éclampsie avec une grande lacération de la langue, compliqué de mort foetale in utero, d\'anémie, d\'insuffisance rénale aiguë et d\'atteinte cérébro-vasculaire. Après induction du travail, elle accouche d\'un mort-né de sexe féminin de 28 semaines d\'âge gestationnel. Nous avons observé un aspect gangreneux de la langue 4 jours après la suture et le débridement etait fait. La patiente est sortie au 12è jour d\'admission avec un trouble d\'élocution à type de palilalie mais son état général était satisfaisant. Le personnel de santé (médecin et infirmier) devrait être informé sur le fait que l\'hémorragie suite à des lacérations de la langue chez une patiente éclamptique peut être suffisamment sévère pouvant être responsable de morbidité et même de mortalité. La reconnaissance de ces cas à haut risque suivi d\'un transfert adéquat devrait être souligné aux sages-femmes et autres prestataires de soins dans les centres de santé. Keywords: Severe tongue laceration - Massive hemorrhage - Eclamptic grandmultipara -Maternal mortality - Intrauterine fetal death.Clinics in Mother and Child Health Vol. 4 (1) 2007: pp. 683-686

Although considered a safe modality for monitoring spinal cord function, motor evoked potentials (MEP) may cause tongue laceration in rare cases. Bite blocks are essential in order to prevent tongue and mucosal injury during monitoring with MEP, but there is no consensus on the ideal bite block to use for this purpose. Potential concerns include tongue necrosis from prolonged use of an oral airway as a hard bite block, and TMJ dysfunction caused by occlusal interference when blocks interrupt the normal occlusal surface. We had a case of tongue laceration during MEPs. Bite blocks should be placed prior to the start of monitoring to prevent teeth occlusion. Because rigid bite blocks may cause pressure injury to oropharyngeal structures soft bite blocks are recommended. The bite block needs to be placed in a way to prevent occlusion by both front teeth and molars and to keep the tongue in the middle of the mouth. Ongoing vigilance to bite block placement is strongly recommended.

Electroconvulsive therapy (ECT) had been used for psychiatric diseases such as depression. Recently, modified ECT is preferred, where the patient is in a state of muscle relaxation induced by muscle relaxant before the influx of electrical current. Although muscle relaxant is used, forceful jaw clenching is inevitable during ECT, since masticatory muscles, particularly the temporalis and the masseter, are directly stimulated by the electrical current. Although biting pressure in a conscious individual is usually controlled by a feedback mechanism to avoid excessive strain, this feedback mechanism does not come into action in an anesthetized patient [1]. Therefore, the teeth or other intraoral structures can be injured from biting or invagination during modified ECT. Psychiatric patients are especially vulnerable to intraoral injuries during modified ECT, because they are more likely to have drug-related dry mouth, smoking, and/or alcohol addiction. In xerostomia patients, the change in the pH and the immune function secondary to reduced salivary flow may also lead to an increased risk of intraoral infection [2]. In order to prevent intraoral injury during modified ECT, mouthguards rather than oral airways are used. Various types of gags and mouthguards have been used such as rubber bite blocks, braided guaze gags, gauze wrapped tongue blades and mouthguards. McClure devised a gag made of dental plastic, and also described about molded mouthguards [1]. But individually molded mouthguards like hard rubber bite blocks are so firm that care should be given to prevent soft tissue injuries such as tongue bites which can occur between the teeth and the mouthguard. We would like to describe a tongue laceration case which occurred during modified ECT despite using a mouthguard. A 71-year-old female patient was admitted for modified ECT under the diagnosis of depression. The mouthguard was made of silicone, immersed in hot water before use and transformed to fit the denture of the patient (Fig. 1A). After modified ECT was given, tongue laceration was found, which seemed to have occurred from biting between the mouthguard and the teeth. Tongue laceration was 1.5 cm long and 0.5 cm deep. Neither active bleeding nor hematoma was observed. After physical examination by an otolaryngologist, it was sutured simply with Vicryl 4-0 under local anesthesia (Fig. 1B). The wound recovered well without complication. Fig. 1 The mouthguard in proper position (A). Tongue laceration repaired with a simple continuous suture. The tongue has an irregular and dry fissured surface, which is a typical characteristic of dry mouth (B). Intraoral soft tissue injuries, especially tongue injuries generally recover well after simple treatment because of the abundant blood supply. Most tongue lacerations do not require sutures. Lacerations that should be repaired with suture include bisecting wounds, lateral border wounds, wounds with active hemorrhage, wounds larger than 2 cm, gaping wounds and amputation injuries [3,4]. If the patient cooperates well, tongue laceration can be sutured under local anesthesia using absorbable material such as Vicryl 4-0 [3]. Some lacerations may cause airway complications including intraoral structure swelling and difficult breathing. In the case of hematoma, blood fills the submandibular space, the floor of the mouth becomes full, and then the tongue is forced upwards and backwards, causing an elevation of the tongue and airway obstruction. If swelling and difficult breathing became severe, early nasotracheal intubation or tracheostomy should be considered for airway protection. Extubation should be performed after the swelling subsides. While active arterial bleeding requires intervention, subsequent treatments are usually conservative, such as steroids, antibiotics and reversal of any coagulopathy [5]. Before all else, one should examine the patient's dental and oral condition carefully and check whether the mouthguard fits well to the patient before performing ECT. If necessary, the patient should get dental treatment in advance to ensure his or her safety during ECT.