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Clinical Summary

Injuries to the tongue or mouth floor can cause serious hemorrhage and potential airway compromise. Injury to or absence of teeth should be ascertained by inspecting the wound for possibly entrapped dental elements. Dorsal surface tongue lacerations may be associated with a mandibular surface laceration.

Management and Disposition

Most tongue lacerations do not require repair. Lacerations involving the tip or lateral margins or lacerations greater than 1 cm in length that gape widely or actively bleed are best stabilized by a few rapidly absorbable interrupted sutures using large bites to include both mucosa and muscle. Anesthesia of the anterior two-thirds of the tongue may be obtained by an inferior alveolar/lingual nerve block. Local anesthesia, infiltrated at the site of the wound, may also be used. Tetanus status should be addressed. Good oral hygiene should be maintained by using chlorhexidine 0.12% topically twice a day for a week.

Pearls

  1. Extensive complex tongue lacerations are at risk for infection and should be prophylactically treated with antibiotics covering oropharyngeal microbiota.

  2. Regional anesthesia for tongue laceration repair avoids distortion of the anatomy prior to repair and is generally better tolerated than direct infiltration of local anesthesia into the tongue.

FIGURE 6.21

Tongue Laceration. Due to its length and gaping, this tongue laceration was repaired with absorbable sutures. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 6.22

Tongue Laceration. A stellate tongue laceration that does not require suturing is shown. The ventral aspect of the tongue should be examined for additional lacerations sustained from the mandibular teeth. (Photo contributor: James F. Steiner, DDS.)

FIGURE 6.23

Healing Tongue Edge Laceration. Lacerations of the tip or edge of the tongue should be reapproximated as chronic defects or “forked tongue” may result. (Photo contributor: Lawrence B. Stack, MD.)

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