Clinical management of self-mutilation in a neurologically compromised patient under intensive care

A case report

Abstract

Introduction: Muscular control is a challenging task for neurologically compromised patients. In certain circumstances, tongue protrusion combined with trismus may lead to severe intraoral injuries. Objective: To report a case of self-mutilation of the tongue in a patient with cerebrovascular accident. Case Report: A 60-year-old female patient under treatment in the intensive care unit presented a lesion on the lower surface of the tongue caused by the adjacent teeth. A low-cost intraoral device was developed using thermoplastic (70°-75°C) impression material (Aquaplast 3.2 mm, Aquaplast Corp. Wyckoff, NJ, USA). In general, this material is used to build orthopedic appliances and may adapt to the patient with no need for laboratory procedures. Additionally, the material has moderate resistance, full-memory and good remodeling for dynamic conditions: The device developed in the present case was very effective to protect the teeth and avoid further episodes of self-mutilation. Other studies are necessary to test this device and alternative materials for the protection of intraoral hard and soft tissues.