A man with tongue pain: A case study

Abstract

A 76yearold man presented for the evaluation of episodes of severe unilateral pain along the left posterior aspect of his tongue, tonsillar fossa, and jawline. He described the pain as “electric shocks” that would not last longer than 1 min. The episodic pain increased in frequency and intensity over the course of 1 year and recently started to involve his left ear lobe. Eating and drinking triggered his pain, especially when consuming cold foods and liquids. He described difficulty swallowing due to pain but denied any history of abnormal tongue control to suggest neurogenic motor dysphagia.1 The patient has a past medical history of hypertension, hyperlipidemia, prostate cancer, and restless leg syndrome. He denied any trauma or craniofacial surgery prior to symptom onset. He had a tonsillectomy at a young age but denied any complications or lasting injury due to this surgery. He denied any recent periodontal disease or infection. He was up to date on all recommended vaccinations for his age. Neurological examination did not reveal any focal motor or sensory deficits. His speech was clear with no evidence of speech impairment, but he did report occasional vocal hoarseness and coughing following pain paroxysms. His palate, uvula, and tongue appeared normal with no obvious cranial nerve impairment or muscle wasting. Gentle probing of the left posterior surface of the patient s tongue with a blade reliably incited his sudden, severe pain. He denied any lightheadedness, syncope, or loss of consciousness in conjunction with his symptoms.