The case of an elderly person with a tongue laceration due to a suicide attempt that was thought to be caused by a sleep disorder is presented. The patient was a 67-year-old woman who was found to be bleeding from her oral cavity by her family and was taken to the emergency department of Ushiku Aiwa General Hospital. The history of the injury was that she had had a sleep disorder for more than 10 years and had been on medication for many years. She also said that her sleep disorder had worsened because she had fractured her coccyx a year earlier, and her activities of daily living were severely restricted due to pain. This was her first suicide attempt. The patient’s general condition at the time of consultation was stable. Her injuries were localized to the tongue only. The wound was sutured with hemostatic suture under local anesthesia. She started oral intake on the third day and was discharged on the tenth day, since her course was unremarkable. After discharge, she was followed up for the wound, and she began going to a psychiatrist. She was started on psychiatric medication, her mental state became stable, and her sleep disorder began to improve. One year after the suicide attempt, there was no relapse of suicidal ideation, and the wound had healed well.
Elderly people may have diminished mental and physical functions, may have various medical conditions, and are prone to suicide-related events. If oral self-harm is observed, it is necessary to manage the wound properly and to closely examine the patient’s background leading to suicidal ideation and then prevent any relapse of that ideation.
Although there are numerous reports of oral trauma during eating caused by cutlery such as chopsticks and forks, there have been no reports of accidental wedging into the dental arch caused by spoons, other than accidental ingestion and trauma, as far as we can ascertain. We report the case of a spoon used for meal assistance accidentally wedged into the narrow mandibular dental arch of a woman and that could not be removed from the mouth, causing her visit to our department. The patient, a 44-year-old woman with cerebral palsy, had full assistance with activities of daily living. The person in charge of the facility was feeding the patient a jelly meal with a spoon. When the spoon could not be removed from the patient’s mouth, she was transported to our hospital as an emergency case. The intraoral view showed that the bowl of the spoon, which was wider than the dental arch, was horizontally occluded in the part of the mandibular molar that had an overhang tilting toward the lingual side. Furthermore, the bowl of the spoon was pushed up by the pressure of the tongue and pressed against the overhang of the dental arch, making it difficult to remove. Radiographs showed that the airway was kept open. Owing to only a small amount of bleeding, we considered that the spoon could be removed. By holding the handle of the spoon and pushing down on the tongue, the spoon was disengaged from the overhang of the dental arch and removed. It is important to predict the risk of accidental symptoms in similar situations as the present case when using a spoon.
Wisdom tooth extraction is one of the most frequently performed procedures in the field of oral surgery. Associated complications include bleeding and infection, but fracture of surrounding bone may also occur.
We experienced a case of fracture of the maxilla that occurred during extraction of a maxillary wisdom tooth, which was followed by a serious infection. After making an incision, drainage by anti-inflammatory surgery from inside and outside the oral cavity was performed under general anesthesia, and antibacterial agents were administered. One year later, the patient had no symptoms and bone union was confirmed.