Tongue laceration: Difference between revisions
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==Background== | ==Background== | ||
*Secondary to tongue biting | *Secondary to tongue biting | ||
*Serious injuries can cause hemorrhage and potential airway compromise | *Serious injuries can cause [[hemorrhage]] and potential airway compromise | ||
==Clinical Features== | ==Clinical Features== | ||
*Examine for other injuries, missing teeth, embedded foreign bodies | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ | {{Tongue DDX}} | ||
==Management== | ==Management== | ||
*Do not need primary repair unless >1 cm in length, widely gaping, involving tip, or large hemorrhage | ===Adult=== | ||
**Use absorbable sutures | *Do not need primary repair unless >1 cm in length, widely gaping, involving tip / anterior split tongue, or large hemorrhage | ||
**Anesthesia of the anterior 2/3 of the tongue is obtained through | **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 a [[lingual nerve block]] or topical anesthesia with 4% lidocaine soaked gauze. | |||
**Chlorhexidine mouth wash to prevent infection | **Chlorhexidine mouth wash to prevent infection | ||
===Pediatric patients=== | |||
[[File:TongueLaceration.png|thumb|Graphic for determining need for suturing in <u>pediatric</u> patients with tongue laceration.]] | |||
Who needs suturing (see photo to the right)? <ref>Seller Et al. Tongue lacerations in children: to suture or not? Swiss Med Wkly. 2018;148:w14683 https://smw.ch/article/doi/smw.2018.14683</ref> <ref>Sibley, A., Atkinson, P., & Lobay, K. (2020). Just the facts: Pediatric Dental and Oral Injuries. CJEM, 22(1), 23-26. doi:10.1017/cem.2019.440 https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/just-the-facts-pediatric-dental-and-oral-injuries/D795F04C6B4CA2AA6C894B5BE1A835F0</ref> | |||
#Consult Head & Neck service if any large amputation of tongue. Otherwise, proceed below. | |||
#[[Lidocaine]] | |||
#Anxiolysis - [[Midazolam]] 0.3-0.5 mg/kg intranasal (max 10kg) or [[Ketamine]] 3-6 Mg/kg intranasal | |||
#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). | |||
#Irrigate and inspect | |||
#Suture - many options exist (1 single deep suture through all 3 layers, 1 suture above and 1 below) | |||
#Follow-up - Soft diet for 3 days, antiseptic (dilute peroxide) swish and spit, antibiotics not needed unless wound is dirty | |||
==Disposition== | ==Disposition== | ||
*Typically outpatient | |||
==See Also== | ==See Also== | ||
| Line 23: | Line 36: | ||
==References== | ==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. | |||
<references/> | <references/> | ||
Revision as of 21:52, 20 February 2020
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
Adult
- 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 a lingual nerve block or topical anesthesia with 4% lidocaine soaked gauze.
- Chlorhexidine mouth wash to prevent infection
Pediatric patients
Who needs suturing (see photo to the right)? [1] [2]
- Consult Head & Neck service if any large amputation of tongue. Otherwise, proceed below.
- Lidocaine
- Anxiolysis - Midazolam 0.3-0.5 mg/kg intranasal (max 10kg) or Ketamine 3-6 Mg/kg intranasal
- 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).
- Irrigate and inspect
- Suture - many options exist (1 single deep suture through all 3 layers, 1 suture above and 1 below)
- Follow-up - Soft diet for 3 days, antiseptic (dilute peroxide) swish and spit, antibiotics not needed unless wound is dirty
Disposition
- Typically outpatient
See Also
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.
- ↑ Seller Et al. Tongue lacerations in children: to suture or not? Swiss Med Wkly. 2018;148:w14683 https://smw.ch/article/doi/smw.2018.14683
- ↑ Sibley, A., Atkinson, P., & Lobay, K. (2020). Just the facts: Pediatric Dental and Oral Injuries. CJEM, 22(1), 23-26. doi:10.1017/cem.2019.440 https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/just-the-facts-pediatric-dental-and-oral-injuries/D795F04C6B4CA2AA6C894B5BE1A835F0