Facial piercings are increasingly common. While external piercings, such as ear and eyebrow rings, are visibly apparent, intraoral and extraoral piercing may not be readily visible on initial inspection. An awareness and suspicion for recent lip, labret, tongue, or other oral mucosal piercings should be performed in any trauma patient as they may cause intraoral damage, produce artifact and diminished CT scan quality if not removed, and interfere during intubation. Common nontraumatic complications of intraoral include peri-piercing cellulitis, abscess formation, hemorrhage, penetrating wounds, dental injury, and granuloma or keloid formation around a stud. Although infrequent, systemic infection may result. If the ball comes off the post, it may be swallowed or, rarely, aspirated. Playing with tongue rings may result in lingual surface tooth abrasion, erosion, chipping, fracture, and gingival resorption.
Management and Disposition
Piercing should be removed prior to any CT scan if possible. For localized hemorrhage after a recent piercing, direct pressure should be applied. If bleeding persists, consider removal of the piercing. Any infection surrounding a piercing warrants removal of the stud as it will serve as a nidus for continued infection. Chest radiographs are required to evaluate for stud aspiration. Advise patients with chipped teeth to remove the bar; these patients should be treated for the commensurate form of dental fracture.
Tongue Piercing Cellulitis. This patient presented with fever and tongue pain surrounding his piercing site. Note the erythema and swelling of the tongue and sublingual areas extending from the piercing site (central bubble). (Photo contributor: David Effron, MD.)
Remove piercings prior to cross-sectional imaging.
Piercings may act as a nidus for ongoing infection if not removed.
Ensure the prompt identification and removal of intraoral and extraoral piercings in any trauma patient potentially requiring emergent airway management, as the presence of jewelry can be a hindrance to successful intubation.
Oral Piercing Complication. This patient suffered a painful injury when the stud of her lip ring came off, resulting in the penetration of her gingiva and inability to open her mouth. (Photo contributor: Lawrence B. Stack, MD.)
Oral Piercing Complication. A close-up photograph of the oral piercing complication seen in Fig. 6.70. (Photo contributor: Lawrence B. Stack, MD.)