Traumatic Macroglossia Associated With Clustered Epileptic Seizures in a Patient With Down Syndrome

Traumatic macroglossia is rare but can cause acute upper airway obstruction and become life-threatening, requiring prompt intervention. We report a case of traumatic macroglossia in a 30-year-old woman with Down syndrome and drug-resistant epilepsy, triggered by tongue biting during clusters of tonic seizures. The patient was admitted for seizure control; however, seizures persisted despite modification of antiseizure therapy. On hospital day 6, she developed rapidly progressive tongue swelling accompanied by fever. During observed seizures, the tongue was repeatedly caught between the dental arches. The tongue showed ulcerative lesions, purulent exudate, marked edema, and congestion. To prevent further injury, a custom-fabricated bite block was used. Empiric broad-spectrum antimicrobials, systemic corticosteroids, and antihistamines were initiated. With close collaboration among the oral surgery, otorhinolaryngology, and intensive care teams and with preparation for possible emergency airway intervention, conservative management was selected. Further optimization of antiseizure therapy reduced seizure frequency, followed by improvement in tongue swelling. The patient recovered without invasive airway management. This case illustrates that severe traumatic macroglossia can result from seizure-related tongue biting but may be managed without invasive airway intervention through careful airway assessment, mechanical protection with an effective bite block, and appropriate adjunctive pharmacotherapy.