Tongue laceration: Difference between revisions
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==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 | ||
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===Pediatric patients=== | ===Pediatric patients=== | ||
[[File:TongueLaceration.png|thumb]] | [[File:TongueLaceration.png|thumb|Graphic for determining need for suturing in <u>pediatric</u> patients with tongue laceration.]] | ||
Who needs suturing | 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. | #Consult Head & Neck service if any large amputation of tongue. Otherwise, proceed below. | ||
#[[Lidocaine]] | #[[Lidocaine]] | ||
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