Clinical decision making for anterior and posterior lingual abscess: a systematic review

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Australian Journal of Otolaryngology


Background: Lingual abscess is a rare clinical entity defined as an infectious process within the tongue parenchyma. A lingual abscess may occur in the anterior two thirds or posterior aspect of the tongue. Historically, there are differences in causation, presentation and management between anterior and posterior based abscess. This systematic review aims to critically analyse differences between anterior and posterior lingual abscess. Methods: A systematic review was conducted using the terms “lingual abscess”, and “tongue abscess” across the databases PubMed, SCOPUS, Medline, Embase and Google Scholar. Further articles were identified through citation screening of the selected articles. The authors included articles published from 1970 to 2023, published in English that reported cases of lingual abscess. Risk of bias was assessed using a standardized tool. Results: A total of 53 studies with 73 cases of lingual abscess were identified. There were 45 (61.6%) anterior, 26 posterior (35.6%) and 2 (2.8%) total aspects of the tongue. Clinical presentation of otalgia (25.9% vs. 2.2%, P=0.002) and sialorrhoea (18.5% vs. 4.3%, P=0.047) was significantly more likely in a posterior located abscess, along with involvement of the epiglottis compared to anterior abscess (18.5% vs. 0.0%, P=0.002). An anterior abscess was significantly more likely to have no radiographic imaging (41.3% vs. 7.4%, P=0.002) or ultrasound (17.4% vs. 0.0%, P=0.022), whereas a posterior abscess was significantly more likely to receive computed tomography scanning (85.2% vs. 34.8%, P<0.001). No significant difference was seen between anterior and posterior lingual abscess in relation to drainage management, isolated pathogens, or antimicrobial prescribing. Conclusions: A low threshold for imaging should be considered when patients present with signs and symptoms consistent with a posterior lingual abscess. Management principles should involve maintaining airway patency, drainage of the abscess and antimicrobial therapy.

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