Difference between revisions of "Tongue laceration"

(Management)
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**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 an 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
+
 
 +
===Pediatric patients===
 
[[File:TongueLaceration.png|thumb]]
 
[[File:TongueLaceration.png|thumb]]
 
**0) Who needs suturing? See photo to the right or articles 1<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> and 2<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>
 
**0) Who needs suturing? See photo to the right or articles 1<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> and 2<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>
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**6) Suture - many options exist (1 single deep suture through all 3 layers, 1 suture above and 1 below)
 
**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
 
**7) Follow-up - Soft diet for 3 days, antiseptic (dilute peroxide) swish and spit, antibiotics not needed unless wound is dirty
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 +
==Disposition==
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*Typically outpatient
  
 
==See Also==
 
==See Also==

Revision as of 21:32, 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

  • 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

Pediatric patients

TongueLaceration.png
    • 0) Who needs suturing? See photo to the right or articles 1[1] and 2[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