Tongue Lacerations 

Most tongue lacerations do not require sutures!

Indications for repair

• Bisecting wounds
• Large flaps
• Persistent bleeding
• Wounds larger than 1 cm
• Gaping wounds
• U-shaped lacerations
• Avulsion or amputation injuries
  • May be primarily closed if the defect is less than 30% of the tongue 

Contraindications for repair

• Small flaps may be simply excised
• Tongue lacerations in children are known to heal well without intervention
• Simple linear lacerations, especially if centrally located, heal with minimal risk of infection
• Amputations or avulsions of >30% require a flap procedure, refer to a specialist

 
Anesthesia

1. Topical anesthesia with lidocaine 4% on gauze for 5 minutes
2. Local infiltration with lidocaine 1%
3. Lingual nerve block for the anterior two thirds of the tongue
   1. http://youtu.be/Yhu4ROEP4ZA
4. Procedural sedation

Repair

• All tongue sutures frequently come untied
  • Bury stitches or tie MANY knots
  • Avoid nylon in the mouth and tongue.
• Three-layer technique
  • 4-0 absorbable sutures, first close the muscular mucosa then the inferior mucosa, then the superior mucosa.  
• Two-layer technique
  • Use one stitch to approximate half the thickness of the tongue superiorly and another stitch to approximate half the thickness inferiorly.
  • Close the edges of the tongue.

• One-layer technique
  • Use a deep absorbable suture to close only the muscular layer
  • This technique is successful because of the rapidly healing superficial mucosa.

Special Instructions

• After repair, the patient should eat a soft diet for 2-3 days
  • If local block performed, no chewing for next 12 hours (can chew insensate tongue!)
• Daily dilute peroxide mouth rinses should be used.