What is the best approach for healing a tongue laceration?

Management of Tongue Lacerations

For most tongue lacerations, conservative management with oral hygiene measures and supportive care is the best approach for healing, while complex or severe lacerations may require suturing. 1, 2

Assessment of Tongue Lacerations

• Evaluate the laceration for complexity, size, presence of flaps, and active bleeding 3
• Complex injuries, large flaps, and active bleeding are indications for suture repair 3
• Midline lacerations may have better prognosis as they typically spare neurovascular structures 3

Conservative Management (For Minor Lacerations)

• Clean the mouth daily with warm saline mouthwashes to reduce bacterial colonization 1, 2
• Use antiseptic oral rinses twice daily (1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash) 1, 2
• Apply mucoprotectant gel (e.g., Gelclair) three times daily to form a protective coating over the laceration 1, 2
• Apply white soft paraffin ointment to the lips every 2 hours if they are also affected 1, 2

Pain Management

• Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating 1, 2
• For more severe pain, apply topical anesthetic preparations such as viscous lidocaine 2% (up to 3-4 times daily) 1, 2
• Consider topical NSAIDs (e.g., amlexanox 5% oral paste) for severe pain 1

Surgical Management (For Complex Lacerations)

• Suture repair is indicated for:
  • Complex injuries with irregular edges 3, 4
  • Large flaps that may interfere with function 3, 4
  • Active bleeding that doesn't stop with pressure 3, 4
  • Full-thickness lacerations, especially those creating a bifid appearance 3
• Consider consultation with a specialist for complex repairs, particularly in children 5, 4

Anti-inflammatory Treatment

• For significant inflammation, consider topical corticosteroids:
  • Betamethasone sodium phosphate 0.5 mg in 10 mL water as a 3-minute rinse-and-spit preparation four times daily 1, 2
  • For localized ulcers, clobetasol propionate 0.05% mixed in equal amounts with Orabase applied directly to the affected areas daily 1, 2

Prevention of Secondary Infection

• Monitor for signs of infection (increased pain, swelling, purulent discharge) 1, 2
• If candidal infection is suspected, treat with nystatin oral suspension 100,000 units four times daily for 1 week 1, 2
• Alternatively, use miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week 1, 2

Special Considerations for Children

• Most tongue lacerations in children occur due to falls when the tongue is between the teeth 6, 5
• The Zurich Tongue Scheme provides evidence-based recommendations for uncomplicated tongue lacerations in children, often favoring spontaneous healing over general anesthesia and primary closure 5
• Parental reassurance is important as these injuries often cause significant anxiety 6

Follow-up Care

• Monitor healing progress and watch for complications such as infection or functional impairment 1
• Most uncomplicated lacerations heal well with conservative management 5
• Long-term complications are rare but may include scarring that affects tongue mobility or speech 3

Common Pitfalls to Avoid

• Premature discontinuation of oral hygiene measures before complete healing 1
• Failure to recognize lacerations requiring surgical intervention 3, 4
• Inadequate pain management leading to decreased oral intake 1, 2