Tongue laceration

Background

• Secondary to tongue biting
• Serious injuries can cause hemorrhage and potential airway compromise

Clinical Features

• Examine for other injuries, missing teeth, embedded foreign bodies

Differential Diagnosis

Tongue diagnoses

• Tongue laceration
• Strawberry tongue
• Black hairy tongue
• Oropharyngeal candidiasis (oral thrush)
• Hairy Oral Leukoplakia
• Tongue swelling
  • Trauma
  • Angioedema
    • Hereditary
    • Allergic (ACE)
    • Idiopathic

Management

• Do not need primary repair unless >1 cm in length, widely gaping, involving tip / anterior split tongue, or large hemorrhage
  • Use absorbable sutures, chromic gut or vicryl but not fast absorbing
  • Tie 4-5 knots but approximate loosely to allow for swelling
  • Anesthesia of the anterior 2/3 of the tongue is obtained through an lingual nerve block or topical anesthesia with 4% lidocaine soaked gauze.
  • Chlorhexidine mouth wash to prevent infection
• In pediatric patients
  • 1) Consult Head & Neck service if any large amputation of tongue. Otherwise, proceed below.
  • 2) Lidocaine
  • 3) Anxiolysis - Midazolam 0.3-0.5 mg/kg intranasal (max 10kg) or Ketamine 3-6 Mg/kg intranasal
  • 4) Retraction - Clamp tongue with towel and pull tongue forward. Consider placing O-silk suture midline in tongue for added traction, but be careful to avoid lingual artery when puncturing (go midline and as anterior as possible when puncturing).
  • 5) Irrigate and inspect
  • 6) Suture - many options exist (1 single deep suture through all 3 layers, 1 suture above and 1 below)
  • 7) Follow-up - Soft diet for 3 days, antiseptic (dilute peroxide) swish and spit, antibiotics not needed unless wound is dirty

See Also

• Tongue Diagnoses
• Lacerations

References

• Ud-udin Z and Gull S. Should minor mucosal tongue lacerations be sutured in children? Emerg Med J. 2007 Feb; 24(2): 123–124.
• Tongue lacerations. A. Patel. BDJ 204, 355 (2008) Published online: 12 April 2008. doi :10.1038/sj.bdj.2008.257.