Spontaneous genial tubercle fracture: management of a rare condition and literature review

The aim of the study was to report on a case of isolated spontaneous fracture of the genial tubercles, an uncommon pathological condition, the onset of which may be associated with non-specific but potentially life-threatening signs and symptoms, such as haematoma or swelling of the oral floor. We conducted a literature review to identify similar cases, focusing on their diagnosis, management and causes. To date, only 15 cases of spontaneous genial tubercle fracture have been described in 14 reports in the English medical literature. Patients were mainly female, with a mean age of 70 years. Only 5/15 cases (33%) were managed surgically, the others (66%) conservatively. A full functional recovery of the tongue movements, swallowing and talking is achievable with conservative therapy in most cases, but surgery is indicated for patients with persistent dysfunction or clinical discomfort. The case described here was treated conservatively, consistently with the literature, with active observation, corticosteroids and prophylactic i.v. antibiotic therapy leading to a complete recovery within a few weeks. Though extremely uncommon, genial tubercle fracture should be included in the differential diagnosis of haematoma and swelling of the oral floor. It is potentially life-threatening, requiring active monitoring and careful airway management. Conservative procedures and a long-term follow-up are needed to control possible functional restrictions and symptoms, and surgical treatment should be considered in refractory cases.