Arteriovenous malformations of the brain--curable epilepsy.

The diagnosis of lingual abscess in the anterior two-thirds of the tongue is simple in view of the characteristic symptoms and signs. Our patient’s initial diagnosis was confused, possibly because of his lack of communication and the fact that he was apyrexial. Hereditary angioneurotic oedema, caused by C1 esterase inhibitor protein deficiency, usually presents with a triad of symptoms and signs, namely abdominal pain, peripheral non-pitting oedema, and laryngeal oedema. Lingual abscess is an extremely rare condition. The tongue is very resistant to infection due to factors such as a thick keratinised epithelial layer, resistance of muscle to infection, cleansing action of saliva, abundant vascularity, paucity of submucosal areolar tissue, and contact exposure of the tongue to bacteria resulting in immunity. The aetiological factors in the formation of tongue abscesses include dental or foreign body trauma, acute parenchymous glossitis, infected circumvallate papillae, upper respiratory tract infections, and carious teeth as present in our patient. The symptoms include severe tongue pain, decreased movement of the tongue (protrusion), hyper-salivation, dysphagia and voice change. The most common site is the anterior two-thirds of the tongue. Abscesses of the lingual tonsil, extension of infections from the molar teeth, and intralingual thyroglossal duct cysts need to be borne in mind when an abscess is located within the tongue base. Pyrexia is not necessarily present and the WCC and ESR are variable. The organisms responsible are usually Staphylococcus aureus and Streptococcus haemolyticus. Both ultrasound (US) and computed tomography (CT) have been utilised to aid diagnosis.