Difference between revisions of "Tongue laceration"

(Management)
(6 intermediate revisions by 2 users not shown)
Line 10: Line 10:
  
 
==Management==
 
==Management==
 +
===Adult===
 
*Do not need primary repair unless >1 cm in length, widely gaping, involving tip / anterior split tongue, or large hemorrhage
 
*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
 
**Use absorbable sutures, chromic gut or vicryl but not fast absorbing
 
**Tie 4-5 knots but approximate loosely to allow for swelling  
 
**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.  
+
**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
*In pediatric patients
+
 
**1) Consult Head & Neck service if any large amputation of tongue. Otherwise, proceed below.
+
===Pediatric patients===
**2) [[Lidocaine]]
+
[[File:TongueLaceration.png|thumb|Graphic for determining need for suturing in <u>pediatric</u> patients with tongue laceration.]]
**3) Anxiolysis - [[Midazolam]] 0.3-0.5 mg/kg intranasal (max 10kg) or [[Ketamine]] 3-6 Mg/kg intranasal
+
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>
**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).
+
#Consult Head & Neck service if any large amputation of tongue. Otherwise, proceed below.
**5) Irrigate and inspect
+
#[[Lidocaine]]
**6) Suture - many options exist (1 single deep suture through all 3 layers, 1 suture above and 1 below)
+
#Anxiolysis - [[Midazolam]] 0.3-0.5 mg/kg intranasal (max 10kg) or [[Ketamine]] 3-6 Mg/kg intranasal
**7) Follow-up - Soft diet for 3 days, antiseptic (dilute peroxide) swish and spit, antibiotics not needed unless wound is dirty
+
#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==
 
==See Also==

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

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

Graphic for determining need for suturing in pediatric patients with tongue laceration.

Who needs suturing (see photo to the right)? [1] [2]

  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

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.
  1. 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
  2. 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