Eclampsia is a serious complication of pregnancy which refers to seizure activity or coma unrelated to other cerebral conditions and can cause significant mortality and morbidity in pregnant woman [1]. It is often associated with multi-organ failure if timely intervention is not performed [2]. Oro-facial injuries during eclampsia, having an incidence as high as 42%, can be a serious cause of concern and are an additional factor that can result in mortality [3,4]. Most injuries are due to bite and forceful insertion of hard objects into the patient's mouth by relatives during convulsive episodes [5].

This is a rare case of severe tongue bite during eclamptic convulsion. This 30 year old fifth gravida with 8 months pregnancy developed convulsions while she was at home in a remote village 250 kilometres away from our hospital. In the course of the convulsive fit, her tongue got tightly trapped between her teeth. Her husband immediately tried to open her jaws and reposited the tongue. The patient was managed at the local public health centre and referred to our hospital. On the 4 hours drive to the hospital, the patient developed convulsions once again and suffered another tongue bite. Since her husband was driving and there was no companion, he could not reposit it back. When the patient arrived at our emergency room, she was semi-conscious; her bitten tongue was protruded and tightly clenched in her jaws (Figure 1). The tongue was bleeding and there was caked blood on her cheeks.

Figure 1: Bitten tongue was protruded and tightly clenched in her jaws.

The eclampsia was treated and the patient delivered a still born female child. The bitten tongue was put back in place and an Otorhinolaryngologist was called on the bedside for consultation. Since the bleeding had stopped she was advised conservative treatment with local antibiotic and anesthetic gels applied on the tongue. On reviewing the case after three days, it was determined by the otorhinolaryngologist that the patients tongue required surgical repair. Thus, on the fourth day after she was admitted her tongue was repaired by stitching in two layers (Figure 2).

Figure 2: After admittion her tongue was repaired by stitching in two layers.

The tongue bitten by violent clenching of teeth or jaws.

Orofacial injuries arising from seizure-related disorders are well-recognised and they vary from bruises of perioral and intraoral structures especially the lips, gingivae and tongue to facial bone fractures. The soft tissues, especially the tongue and lips, could be traumatised from biting as a result of the vigorous jaw movement that usually accompanies an eclamptic convulsion. An obstetricians should be aware of the possibility of the presence of these injuries in an unconscious eclamptic patient and their life-threatening consequences if not promptly diagnosed and managed. And Consultation from oro maxillary surgeon should always be done.

This case merits attention due to the fact that the injury was so severe that it required surgical repair after four days of admission and it took two weeks for complete healing.