Traumatic lingual hematoma (LH) is an uncommon condition that can rapidly progress to life-threatening upper-airway obstruction. The tongue is a richly vascular structure, mainly supplied by branches of the lingual artery. The majority of LHs are traumatic or spontaneous; the latter are often associated with the use of thrombolytics or other anticoagulants. To our knowledge, there are no reports documenting bilateral TMJ dislocation as a complication. We report a case of traumatic LH complicated by thrombocytopenia, which necessitated airway management with limited options. We will discuss airway stabilization in the setting of a large anterior airway obstruction, treatment of a traumatic LH, and a previously unreported complication of LH resulting in bilateral TMJ dislocations.

CASE REPORT

A 39-year-old man with a history of alcohol abuse was brought into the Emergency Department (ED) by ambulance due to an unwitnessed fall and suspected alcohol withdrawal seizure. Upon arrival the patient was alert and oriented with no evidence of acute respiratory compromise, despite a muffled voice and a large LH. He had no complaints and denied shortness of breath. Past medical history was significant only for alcohol abuse, but he had not imbibed for 24 h. He denied use of anticoagulants, angiotensin-converting enzyme (ACE) inhibitors, or history of allergic reaction. He also denied a prior history of tongue swelling or difficulty closing his mouth. He stated that both started while he was being transported to the hospital and were progressively getting worse. On arrival, the patient had a heart rate of 155 beats/min, temperature of 37.9
C, respiratory rate of 17 breaths/min, room air oxygen saturation of 100%, and a blood pressure of 191/121 mm Hg.