Nonsuicidal Self-Injury Comprising Partial Autoamputation of
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Nonsuicidal self-injury (NSSI) is usually described as the deliberate, direct destruction or alteration of body tissue without conscious suicidal intent, and it is a unique risk factor for suicide . Nonsuicidal self-injury occurs among 17.2% of adolescents, 13.4% of young adults, and 5.5% of older adults. It often occurs in patients with psychiatric disorders such as schizophrenia , autism , and depression , and the target of NSSI is often the skin, eyes, or genitalia . Much of the described NSSI in the oral cavity has been minor, because the gingival tissues are the most frequent site of injuries and the tools have usually been toothbrushes and brush picks.

A 69-year-old female presented with autoamputated the apex of her tongue with scissors. She had a 10-year history of schizophrenia but had defaulted from psychiatric intervention and stopped taking prescribed medication. She also had parasomnia with arousal disorders. She arrived at the emergency room three hours after the autoamputation . Her vital signs were stable. Although blood oozed from the major portion of the tongue, the lingual arteries were not damaged . No other lacerations were evident, and the mobility of the remaining portion of the tongue was normal. The amputated portion was missing; thus, the remainder of the tongue was debrided and sutured using Vicryl® Plus antimicrobial coated sutures under local anesthesia (xylocaine 2% with adrenaline)The patient was prescribed with loxoprofen sodium hydrate for pain control and amoxicillin hydrate to avoid infection. postoperative instructions including oral hygiene and a soft diet are provided. The importance of resuming psychiatric treatment for schizophrenia and follow-up are described.

In conclusion non suicidal patients who mutilated their tongues using edged tools after sleep disturbances. The prevalence of NSSI has recently increased, and concerns have been raised about the potential normalization of self-mutilation. Although such patients are rare, medical providers including dentists and oral surgeons should be aware of the increasing likelihood that a patient will present with a major NSSI seeking emergency treatment late at night.

Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057006/
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