Medicals

Fork in the mouth !

No, it is not about Fork to Mouth Disease (FTMD) (i.e. fat/overweight people living in denial and believing that their weight gain is from an over-active pituitary or thyroid gland – according to urban dictionary). It is literally a fork stuck in the mouth.

One evening, during my very first week as a junior resident at the casualty, my senior colleague rushed into the senior medical officer (SMO)’s office, where the SMO and I were having a conversation, reporting that he was just seeing a case with a fork in the mouth. Once we both assumed she was stabbed. He read our face and immediately said, “no, she was not stabbed”. We went to the emergency room right away where a young lady, about in her 30s, was sitting in the bed comfortably with the fork attached in her mouth.

She mumbled that she was just eating her lunch and the fork got stuck in her tongue. She claimed that no one troubled her. The SMO said, “Okay, let me take a look”. She could open her mouth normally, which means her temporomandibular (TM) joint is normal. The fork was just trapped on the surface of the tongue without any penetration. The tongue muscle was squeezing it tightly. I regret that I didn’t take any picture of it. I really wish you guys to see. Anyway, don’t worry, I just drew a sketch by “FreshPaint” which I like most among Microsoft Windows apps.

Image

We tried to pull out with normal force but it didn’t work as she was in terrible pain. I never know tongue muscle is that strong gripping the fork as if that is its own. Also, the lower teeth seemed to be a kind of barrier to come out easily. The SMO asked us to ascertain that the fork is not penetrating at all by putting a finger between the tongue and the fork. And then, he asked the nurse to prepare a gauze soaked with adrenaline explaining to us he was just taking a precaution just in case it bled or hematoma formed. Then, he asked the lady to relax and just pulled out with a brisk force like we pull out the chest tube. Everything was perfect. There was no bleeding or trauma. The lady thanked our SMO and left. He said we should keep that fork to show other doctors.

So, how could that happen? The SMO admitted that he has never seen such a case in his life with the experience of over 35 years of medical practice. Is it something wrong with hypoglossal nerve? When I googled it, I just found a few possible differential diagnoses that can cause tongue spasm or involuntary contraction of the tongue muscle.

The first one is Meige’s syndrome. (Don’t confuse with Meigs syndrome which is a triad of ovarian tumor, ascites and pleural effusion) That one is also know as Brueghel’s syndrome and oral facial dystonia. It mainly affects TM joint and eye muscles (blepharospasm)Another possible differential should be Tourette syndrome.

Share your knowledge in the comment session below, please.

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