- Secondary to tongue biting
- Serious injuries can cause hemorrhage and potential airway compromise
- Examine for other injuries, missing teeth, embedded foreign bodies
- Tongue laceration
- Strawberry tongue
- Black hairy tongue
- Oropharyngeal candidiasis (oral thrush)
- Hairy Oral Leukoplakia
- Tongue swelling
- Allergic (ACE)
- 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
- Consult Head & Neck service if any large amputation of tongue. Otherwise, proceed below.
- 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
- Typically outpatient
Special Lacerations by Body Part
- 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