Definition:—An acute inflammation involving the parenchyma of the tongue, characterized by swelling, pain and dyspnea, usually terminating in resolution, but occasionally ending in abscess.
Etiology:—The disease seldom occurs spontaneously. It results from burns, from hot food or beverages, or from corrosive acids or alkalies, or from accidentally biting the tongue, or from the bites of insects. The disease has occurred as the sequel of other acute inflammatory diseases.
Symptomatology:—There are but few premonitory symptoms. Swelling of the tongue develops rapidly, accompanied with distress and pain. The tongue is tender and some difficulty in swallowing is at once experienced. The swelling increases until the tongue may protrude from the mouth. The difficulty in swallowing increases, talking is impossible, and breathing is obstructed, producing great distress and ultimately threatening suffocation. The tongue is very sensitive and painful. It becomes discolored, is dark red and finally glossy, and may be very dry, cracked and fissured. Occasionally it is furred with a dirty white or yellowish white fur, and there is a profuse flow of saliva. The salivary glands also may be swollen.
With the onset of the disease the temperature rises to 103.5° or 104° F., the pulse quickens, the patient becomes restless and anxious, and the countenance shows great distress. The inflammation reaches its highest point in about three days, when all the symptoms gradually abate, until at the end of one week the disease has subsided. In cases where resolution does not occur and abscess forms, the abatement of the symptoms may not be marked until the abscess discharges spontaneously, which is sometimes the first evidence of its existence, as it is usually impossible to obtain fluctuation. The abscess is circumscribed, and is usually on one side of the tongue.
Diagnosis:—The pain and sudden swelling of the tongue and dyspnea are unmistakable evidences of the disease.
Prognosis:—The disease usually terminates favorably, as stated, by resolution. When occurring as a complication to or the sequel of severe prostrating disease, the prognosis must be guarded, and under these circumstances the disease becomes serious.
Treatment:—In the treatment of the case the internal use of aconite and belladonna at the onset is important to control the inflammation and to dissipate the developing primary congestion. A mouth wash should be used freely, consisting of two parts of a weak, strained infusion of white oak bark (one-half ounce to the pint of boiling water, to which a dram of boric acid is added while hot) and one part of the distilled extract of witch-hazel. This should be taken freely cold, and held in the mouth, and at the height of the inflammation small pieces of ice should also be frequently taken and dissolved slowly. A mouth wash of an infusion of marshmallows, hydrastis and sodium biborate, or potassium chlorate, is of frequent benefit, but less immediately serviceable than the one first named. If the tongue protrudes, it should be frequently bathed with a solution of sodium biborate and glycerin, to prevent extreme dryness, or a soft piece of gauze saturated in the mixture may be kept applied. If septic infection is present, or if the glands are involved, the internal use of echinacea and phytolacca is important.
The inhalation of the vapor of steam, or steam from water to which a few drops of the tincture of iodin, or a few drops of the oil of eucalyptus, or a dram or two of the compound tincture of benzoin, is added, is of apparent benefit in a few cases. It seems to hasten resolution. Counter-irritation will afford some relief in the early stage of aggravated cases, but scarification as suggested by some authors is not advisable.
Only in extreme cases will it be necessary to resort to tracheotomy to relieve the dyspnea, but rectal alimentation is often essential to preserve the strength of the patient.