Tongue laceration

(Redirected from 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

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

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.

Authors:

Ross Donaldson