An amputation of the tongue can happen for medical reasons like cancer of the tongue. It can be due to an accidental trauma and it can be a form of torture in other countries. Finally, a person can auto-amputate their tongue because of a medical or psychological condition.
Amputation of the tongue can be life threatening because of the massive bleeding involved. At least five cases of auto-amputation have been reported in the literature. In one case, a mentally retarded patient had received an injection of flupenthixol. The self mutilation came because of a neuroleptic induced atypical orolingual dyskinesia.
Psychotic patients have been known to engage in self injurious behavior that results in a self-inflicted glossectomy. Sometimes amputation of the tongue happens as a result of a motor vehicle accident in situations where there is an unrestrained passenger that is forced to bite down suddenly on their tongue. Sports related auto-amputation can occur in sports injuries when a patient is not wearing proper mouth protective gear. Self inflicted tongue amputation has been known to happen when a patient suffers from macroglossia. This is an enlarged tongue that can protrude through the teeth.
Certain neurological conditions can cause auto-amputation of the tongue including encephalitis, cerebral palsy, coma, autism, seizures, mental retardation and familial dysautonomia, Lesch-Nyhan syndrome, Cornelia de Lange syndrome and Tourette’s syndrome. If a patient shows up with an amputation of the tongue, the doctor needs to pay attention to the possibility of these conditions as the cause of the amputation.
In one case, a tongue was surgically salvaged after a traumatic amputation of the tongue. The second reported case of a successful revascularization of a severed tong was reported in the literature. The setting was a situation of facial trauma that included the severed tongue. The left lingual artery and the right lingual vein were used to connect the two halves of the tongue. There was a prolonged period of ischemia before the tongue was attached but it was demonstrated that the tongue can survive for up to 16 hours of ischemia before being too ischemic to tolerate a reimplantation.
The study suggested that just one artery on one side and a vein from the other side are enough to revascularize a tongue, which was different from what medical science once thought. It can be done even in the setting of major facial trauma with a completely normal tongue afterward. There needs to be a large-volume fluid resuscitation during the procedure.
Tongue amputations are extremely rare, happening in auto accidents, sports accidents and situations where the patient has a medical or psychiatric condition that leads to the partial or complete amputation of the tongue. The tongue is considered able to be reattached after a period of around 16 hours or less of complete ischemia. What one study tells us is that it takes just one artery and the contralateral vein to reattach the tongue and establish proper circulation for a normal tongue after the surgery.