The Presidential Tongue

Special report

On Saturday, aug. 5, 2000, former president Gerald Ford, who had been hospitalized because of a basilar cerebral vascular event, underwent incision and drainage of a tongue abscess reported to be due to actinomycosis. He had been complaining of tongue pain for several days.

Comment by stan deresinski, md, facp

Actinomycosis of the tongue is a rare, but well-described infection.

Gerbino and colleagues reviewed this infection and reported that it most often involves the anterior two-thirds of the tongue lateral to the median sulcus, presenting as a painful nodule deep within the muscle, with the mucosa remaining intact for a prolonged period.1 The infection may also involve the base of the tongue, as in two patients who presented with dysphagia.2 The tongue may be indurated and its range of motion limited and the lesion may mimic a neoplasm.3,4 The diagnosis may be made, in some cases, by fine needle aspiration.1

The differential diagnosis includes, in addition to neoplasm, tuberculoma, caused by either Mycobacterium tuberculosis or Mycobacterium bovis.5,6 Abscess of the tongue may also be caused by a variety of bacteria, although most commonly those, like the actinomycetes, of periodontal origin.7-9 The infection may lead to upper airway obstruction.10 The increasingly widespread practice of tongue piercing is likely to lead to an increase of such infections.11 Other infections involving the tongue such as histoplasmosis, paracoccidioidomycosis, or leishmaniasis are more likely to present with ulcerative lesions, as in squamous cell carcinoma and, occasionally, lymphoma.

References

1. Gerbino G, et al. Actinomycosis of the tongue. Report of two cases and review of the literature. Minerva Stomatol 1998;47:95-101.

2. Belmont MJ, Behar PM, Wax MK. Atypical presentations of actinomycosis. Head Neck 1999;21:264-268.

3. Ficarra G, et al. Actinomycosis of the tongue: A diagnostic challenge. Head Neck 1993;15:53-55.

4. Brignall ID, Gilhooly M. Actinomycosis of the tongue. A diagnostic dilemma. Br J Oral Maxillofac Surg 1989;27:249-253.

5. Ramesh V. Tuberculoma of the tongue presenting as macroglossia. Cutis 1997;60:201-202.

6. Pande TK, et al. Primary lingual tuberculosis caused by M. bovis infection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:172-174.

7. Jungell P, et al. Acute tongue abscess: Report of two cases. Int J Oral Maxillofac Surg 1996;25:308-310.

8. Hehar SS, et al. Glossal abscess presenting as unilateral tongue swelling. J Laryngol Otol 1996;110:389-390.

9. Sands M, et al. Tongue abscess: Case report and review. Clin Infect Dis 1993;16:133-135.

10. Munoz A, et al. Primary lingual abscess presenting as acute swelling of the tongue obstructing the upper airway: diagnosis with MR. AJNR Am J Neuroradiol 1998;19:496-498.

11. Farah CS, Harmon DM. Tongue piercing: Case report and review of current practice. Aust Dent J 1998;43: 387-389.