Two individuals with Lennox-Gastaut syndrome (LGS) who had masses on their tongues, presumably as a result of tongue biting during seizures, were described in a new case report.
These cases highlight the importance of regular dental examinations for people with LGS — particularly those who may have difficulty communicating subjective symptoms.
The report, “Reactive bite‐related tongue lesions in cognitively impaired epilepsy patients: A report of two cases,” was published in Special Care in Dentistry.
Due to the loss of consciousness and/or uncontrolled movements that accompany seizures, it is relatively common for such episodes to result in physical injuries. Within the mouth, the most common type of seizure-induced injury is tongue biting.
When a piece of tissue continuously sustains small amounts of physical damage, like that seen in recurrent tongue biting, the body’s healing process can result in the formation of a reactive lesion. Such fibrous growths resemble tumors but are not cancerous.
The new report describes two individuals with LGS who had presumed reactive lesions on their tongues.
The first, a 30-year-old male, was hospitalized after experiencing seizures that resulted in “almost daily” falls. While in the hospital, the patient complained of mouth pain, and was referred to the attached department of dentistry.
The man was found to have a “bean‐sized” growth on the tongue that was presumed to have formed from irritation from his molars. The growth was surgically removed, and the patient’s molars were adjusted to minimize future irritation.
“The postoperative course was favorable,” the researchers wrote.
The second patient was a 45‐year‐old male. His family had noticed blood on the patient’s eating utensils and went to a university hospital for evaluation. However, the man did not complain of subjective symptoms, so only close observation was recommended. Subsequently, the patient experienced an increase in seizure-induced falls, and was brought to the case report researchers’ hospital.
“After hospitalization, his condition worsened to the point that his bedding, the washbasin, and the hospital room floor were stained with blood, and bleeding in the mouth was observed even when he was not eating,” the investigators wrote. This excessive bleeding led to anemia, for which the patient was given iron supplements.
A large mass, with a diameter of 20 mm, was found on the man’s tongue. It had been easily irritated by the nearby molars, leading to the bleeding. Clinicians removed the teeth, which led to reduced mouth bleeding, but the mass itself did not get any smaller.
The mass was then surgically removed. In five years of follow up, there has been no recurrence, the researchers said.
In both of these cases, the researchers suggested, problems in communication between the patients and their healthcare providers played a substantial role in allowing these reactive lesions to form and progress as much as they did.
“The intellectual disability made medical care treatment difficult, due to lack of patient cooperation, suggesting that mere observational follow‐up, without adjusting the irritant teeth or managing local oral hygiene, had allowed the massive lesions to form,” they wrote.
For instance, in both cases, it would have been theoretically feasible to perform surgery using only local anesthesia. However, both of these surgeries were done under general anesthesia due to poor patient cooperation. The authors suggested that having more regular exposure to dental check-ups might increase patient comfort with such procedures, in addition to maximizing the chance for problems to be identified in their early stages.
“It is necessary for cognitively impaired epilepsy patients to have regular dental examinations in order for patients to get used to dental checks, thereby increasing opportunities for critical intraoral [within-the-mouth] observations,” they concluded.