Tongue and lip piercing

Case contributed by Ashesh Ishwarlal Ranchod
Diagnosis certain

Presentation

A restrained driver presented post-MVA with neck pain and headache.

Patient Data

Age: 40 years
Gender: Female
x-ray

Incidental finding of a midline, tongue piercing, obscuring the open mouth (odontoid) view and limiting plain film assessment. In addition, there is a horizontal left-sided, lower lip piercing.

There is evidence of pain and /or muscle spasm and no acute post-traumatic bony abnormalities.

Incidental normal variant- pseudotumor deltoideus (left humerus) on the Swimmer's view.

Case Discussion

A tongue piercing is a popular piercing amongst young females and is occasionally encountered incidentally in the radiology department during emergency imaging, as in this instance. They are often referred to as tongue rings, however, they rarely a ring and so the term is a misnomer and incorrect. They usually consist of a straight barbell and two balls or beads on either end. The metal ones are usually made of stainless steel (MRI incompatible) or titanium. Titanium is generally MRI-safe, however, consider removal prior to imaging to prevent unexpected accidents. Occasionally they may be made of plastic or some other non-metal.

There are multiple types of lip piercings depending on the anatomical location of the upper lip or lower lip, and also central versus paracentral. In addition, they can be vertical or horizontal. In this case, this is an example of a dahlia piercing, near or at the corner of the mouth in reference to the famous murder of the Black Dahlia.

The incidence of body piercings encountered during imaging appears increasing in daily practice and often prevents optimal and appropriate assessment in some instances. When possible consider the removal of the piercing prior to imaging, although this may not be possible in an emergency presentation.

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