Lingual abscess from a grill cleaning brush bristle

Abstract

1) Describe the clinical presentation of a lingual abscess secondary to a foreign body. 2) Discuss the workup of glossopharyngeal neuralgia (GN). 3) Review existing literature. Illustrative case report and literature review generated by PubMed citation search. This is a report of a patient who presented with severe tongue and ear pain, initially diagnosed with glossopharyngeal neuralgia. He subsequently returned with acute neck swelling, altered mental status, and rapidly progressive airway edema. After securing his airway, radiographic imaging confirmed a lingual abscess with a linear foreign body. He was taken emergently to the operating room for neck exploration with incision and drainage of the abscess. Despite inability to locate the foreign body, he had complete resolution of the abscess and airway edema. Subsequent CT scanning confirms the continued presence of the foreign body consistent with a grill cleaning brush bristle. Lingual abscesses are extremely uncommon. Diagnosis may be difficult and as a consequence, when they occur, they may result in airway compromise or sepsis. Major textbooks often omit description of this entity, which has been associated with oral trauma and with retained foreign bodies such as fish bones. This is the first case report of a near fatal lingual abscess due to a bristle from a grill cleaning brush. To date, there has been no published literature describing the development of a lingual abscess secondary to a bristle from a grill cleaning brush. We describe the presentation and management of this condition and how it may mimic glossopharyngeal neuralgia.