What is the treatment for a tongue laceration?

Treatment of Tongue Lacerations

Most tongue lacerations can be managed conservatively without suturing, allowing for spontaneous healing, especially for uncomplicated lacerations less than 2 cm in length that don't involve the tongue tip.

Assessment of Tongue Lacerations

• Tongue lacerations most commonly occur when the tongue is between the teeth during a fall or blow, particularly in early childhood 1, 2
• Careful examination should evaluate:
  • Size of laceration (length in mm)
  • Location (border involvement, through-and-through nature)
  • Whether wound edges gape when tongue is at rest
  • Active bleeding status
  • Functional impairment 2

Treatment Algorithm: The Zurich Tongue Scheme

Conservative Management (No Suturing)

• Indicated for:
  • Lacerations less than 2 cm in length
  • Non-gaping wounds
  • Lacerations that don't involve the tip of the tongue
  • Wounds without active bleeding 2
• Benefits include:
  • Shorter recovery time (median 6.2 days)
  • Lower complication rate (3.3%)
  • Avoidance of anesthesia or sedation 2

Surgical Repair (Suturing)

• Indicated for:
  • Lacerations larger than 2 cm
  • Wounds with gaping edges when tongue is at rest
  • Through-and-through lacerations
  • Lacerations involving the tongue tip
  • Active bleeding that doesn't stop with pressure
  • Complex injuries or large flaps 3, 2
• Note that sutured wounds typically have:
  • Longer recovery time (median 13 days)
  • Higher complication rate (25%) 2

Surgical Repair Techniques

• Local anesthesia (2% lidocaine) may be used for cooperative patients 4
• For children or uncooperative patients, procedural sedation may be necessary 5
• Suturing technique:
  • Absorbable sutures (3-0 or 4-0)
  • Clean wound with 0.1% chlorhexidine solution prior to repair 4
  • Ensure proper alignment of wound edges
  • Healing time for tongue is approximately 3-6 weeks 4

Alternative Repair Methods

• 2-Octyl cyanoacrylate (Dermabond) has been used successfully in select cases:
  • Can be applied without need for local anesthesia
  • Particularly useful in pediatric patients where anesthesia or sedation poses challenges
  • Not officially indicated for intraoral use but has shown good cosmetic results in case reports 5

Post-Treatment Care

• Oral rinses with 0.1% chlorhexidine solution for 1 minute after repair and daily during healing 4
• Soft diet for 3-5 days to avoid further trauma
• Avoidance of spicy, acidic, or hot foods that may cause discomfort
• Regular oral hygiene to keep the wound clean 4
• Follow-up evaluation if no improvement after 2 weeks 2

Common Pitfalls and Complications

• Infection (rare due to high vascularity of tongue)
• Dehiscence of sutured wounds
• Functional impairment (speech, eating)
• Cosmetic concerns with improper healing 2
• Unnecessary suturing of small lacerations that could heal spontaneously leads to longer recovery and higher complication rates 2

Special Considerations

• Severe cases like traumatic bifid tongue (complete midline split) require surgical repair regardless of size 3
• Patients with bleeding disorders may require additional hemostatic measures and consultation with hematology
• For tongue piercings with lacerations, removal of jewelry is recommended during the healing process 4