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 – urban dictionary). It is literally a fork stuck in the mouth.

One evening, in fact, it is my very first week as a junior resident in casualty, my senior colleague came into the 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. Instantly, we all considered she is stabbed. We went there right away and saw a young lady about in her 30s, sitting in bed comfortably with the fork coming out from her mouth.

She mumbled that she was just eating and nobody stabbed her. We said “Ok, let’s have a look”. She could open her mouth normally, meaning her temporomandibular (TM) joint is normal, and we found out the fork just trapped between the floor of the tongue without any penetration. 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 windows 8 apps.

Image

Sorry for the eye pain with the bad drawing 😉

We tried to pull out with normal force but it didn’t work and she was in 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 finger between the tongue and the fork. And then, he asked the nurse to prepare a gauze soaked with adrenaline explaining us 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 then.

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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