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Editor,—The case published by Patelet al recently of autoamputation of the tongue is an unusual life threatening incident worthy of reporting.1 However, the authors' statement that such an occurrence has never before been reported is inaccurate. At least five cases of autoamputation of the tongue have been reported in the English literature.2-6 I had previously been involved in reporting a case of tongue autoamputation in a mentally retarded patient after a flupenthixol injection.2 Self mutilation in this case was secondary to neuroleptic induced acute atypical orolingual dyskinesia. Bizarre and sporadic oral self injurious acts resulting in traumatic glossectomy have been known to occur among psychotic patients.3 Amputation of the tongue has also been documented after a motor vehicle accident, in which the unrestrained passenger was forced to bite down on his tongue with enough force to amputate a segment.4 Furthermore, self inflicted amputation of the tongue has been noted by other authors to cause macroglossia that compromised the upper airway, as well as result in life threatening secondary infections.5 6 Finally, serious oral self mutilation may be a rare pathological behavioural pattern that is observed in various neurological conditions such as encephalitis, coma, cerebral palsy, autism, mental retardation, seizures, as well as familial dysautonomia, Lesch-Nyhan syndrome, Tourette's syndrome, and the Cornelia de Lange syndrome.2Clinicians should be aware of these possible underlying conditions when they are confronted with a patient presenting with such unusual self inflicted oral injuries.
The authors respond:
We wish to thank Dr Pantanowitz for the useful information. In our case report we intended to highlight a case of “spontaneous” autoamputation of the anterior two thirds of the tongue. Unlike a traumatic amputation, this was attached to the base of the tongue with a thin vascularised pedicle and the patient could remove it from the oral cavity and then put it back. Traumatic glossectomy is a extremely common phenomenon and I wonder if it can be labelled as an autoamputation. Hence we did not discuss traumatic glossectomy in our case report.
Our case is also unique because this autoamputation occurred in a patient with carcinoma of the posterior third of the tongue. We do not know if malignancy was the causative factor. Autoamputation in our case was truly spontaneous because there was no history of trauma (accidental or self inflicted), mental retardation, or neurological problems etc.