Misplaced and imprisoned tooth. (Forget.)
Fig. 471
Destruction of cheek the result of cancrum oris. (Tiffany.)
Severe infections of the mouth may also involve the tongue and thus produce acute glossitis or may spread to the connective tissue, or the submaxillary region, and there produce that type of phlegmon called Ludwig’s angina, described in the chapter on the Neck. The source of infection in most of these cases is a tooth or tooth-socket.
Injuries and wounds of the mouth are liable to septic infection, whether they occur from mechanical, chemical, or traumatic causes. Injuries inflicted by the mouth, or rather by the teeth, upon others constitute infected wounds of a serious type. Burns, scalds, and similar lesions inflicted by violent caustics, such as carbolic or nitric acids, may be followed by cicatricial contraction and produce serious consequences. So far as the latter can be foreseen they should be prevented, while for their more extreme results various plastic operations may be performed.
THE TONGUE.
What has been said above with regard to the possibility of infected wounds in the mouth applies also to the tongue and other parts. It is often lacerated by being caught between the teeth in falls and blows and is sometimes bitten by epileptic patients during their convulsions. Free hemorrhage from such wounds may occur and may require ligation of vessels at the site of the wound, or of suture of tissues en masse with catgut, or ligation of the lingual artery just above the hyoid bone. Lacerated wounds should be closed with sutures, and antiseptic mouth-washes should be frequently used.
Glossitis, or inflammation of the structures of the tongue, may appear in either acute or more chronic form. To some extent it is a part of a general stomatitis, but no matter in what form occurring it is an expression of infection from a source easily recognized, and may be limited to one side of the tongue. Its principal features are swelling, which may be so extensive as to prevent movement of the tongue, infiltration of the floor of the mouth, and extension of a phlegmonous type down the structures of the neck. The swelling may also involve the epiglottis and larynx, causing edema and even suffocation unless tracheotomy be performed. Thus acute glossitis may frequently lead to abscess formation either in the tongue or the adjoining tissues. When swelling is extreme its formation may be anticipated, and free incision should be promptly made to permit of its evacuation. Naturally the region of the large vessels should be avoided, and, after external incision the focus should be reached by blunt dissection. Some of these cases are due to extension of an erysipelatous process commencing externally. Even hemiglossitis may be accompanied by serious swelling and high fever. One form of this affection is supposed to be analogous to herpes zoster. The relation of phlegmonous glossitis to Ludwig’s angina, the latter being described in Chapter XLI, may be readily appreciated. Sometimes it is due to the entrance of foreign bodies, as fish-bones, bone-splinters, and the like.