Objective: Here we report a rare case of tongue carcinoma presenting by abnormal movements in the tongue in form of myokymia, and Earache.

Background: Fasciculations can be defined as visible, fast, fine, spontaneous and intermittent contractions of muscle fibers. Tongue fasciculation/myokymia finding in a neurological examination is of concern, given its close relationship with amyotrophic lateral sclerosis; its incorrect to associate fasciculations directly to the injury of fore tip of the spinal cord, because the skeletal pathophysiological involvement can be quite broad. REVIEW OF LITERATURE: Table 1 shows Overview of Tongue fasciculation/Myokymia and local Tongue pathology studies in the literature.

Method: case report

Results: A 49 years old male started to complain of gradual change in character of voice, difficulty in speech and swallowing over the last 4 months with weight loss. Preceded 8 months ago by bilateral earache; ENT examination revealed no local problems. Neurological examination revealed “hot potato” voice, slurred speech, and diffuse tongue fasciculation + atrophy. Another sign was invasion of the frenulum “tongue tie” [Figure 1]. Electromyography and nerve conduction –> minimal decremental response, and patchy myopathy. Post contrast MRI brain –> normal.  Post contrast pan-CT –> picture suggestive of metastatic pulmonary nodules. PET scan [Figure 2] –> hypermetabolic soft tissue lesion in the floor of the mouth + secondary hyper metabolic pulmonary, and lymph nodal metastatic deposits.  Pathology diagnosis –> adenocarcinoma of minor salivary glands. The patient is now treated with radiotherapy as a palliative treatment and is later scheduled for chemotherapy.

Conclusion: Important part of tongue fasciculation/myokymia examination was good inspection with elevation of the tongue and submandibular palpation for masses; and association with earache is usually highly suggestive of local invasions.

References: Antonio M, Leite A, Orsini M, et al. Another perspective on fasciculations: when is it not caused by the classic form of amyotrophic lateral sclerosis or progressive spinal atrophy? Neurol Int. 2014;6:47-51. doi:10.4081/ni.2014.5208 Asano T, Yoshida D, Shirato H, Fukuda S. A Novel Approach to Advanced Carcinoma of the Tongue : Cases Successfully Treated with Combination of Superselective Intra-Arterial Chemotherapy and External / High-Dose-Rate Interstitial Radiotherapy. Jpn J Clin Oncol. 2006;36(12):822-826. Andrews K V, Eveson JW. Myokymia ( fasciculation ) of the tongue as a unique presentation of mucoepidermoid carcinoma. Int J Oral Maxillofac Surg. 2007;36:79-81. doi:10.1016/j.ijom.2006.05.004

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/tongue-myokymia-and-earache-as-a-unique-presentation-associated-with-local-tongue-pathology-a-case-report-and-review-of-literature/