What is the recommended treatment for a traumatic tongue lesion?

Treatment of Traumatic Tongue Lesions

For traumatic tongue lesions, thorough irrigation with tap water or sterile saline followed by observation for secondary healing is the recommended approach for most injuries, with suturing reserved only for large gaping wounds (>2 cm), through-and-through lacerations, or those involving the tongue tip. 1, 2, 3

Initial Assessment and Wound Preparation

Immediate wound management:

• Irrigate the wound thoroughly with running tap water or sterile saline solution until no debris or foreign matter remains 1
• Tap water is as effective as sterile saline and superior to antiseptic agents like povidone-iodine for wound irrigation 1
• For cooperative patients, clean the wound with 0.1% chlorhexidine solution prior to any repair 2
• Control bleeding with gauze pressure and have the patient use a mouth rinse to minimize pooling of blood in the oral cavity 1

Critical red flags requiring immediate medical evaluation:

• Wounds contaminated with human or animal saliva should be evaluated in a medical facility as soon as possible due to high infection risk 1
• Assess for airway compromise from tongue swelling or trauma 1
• Evaluate for concurrent head injury, loss of consciousness, or cervical spine injury 1

Decision Algorithm for Suturing vs Secondary Healing

Indications for PRIMARY CLOSURE (suturing):

• Lacerations >2 cm in length 3
• Through-and-through lacerations (91.7% of sutured cases) 3
• Wounds with gaping edges at rest (91.7% of sutured cases) 3
• Lacerations involving the tongue tip 3
• Active bleeding that cannot be controlled with pressure 2

Indications for SECONDARY HEALING (no suturing):

• Lacerations <2 cm in length 3
• Wounds without gaping edges at rest 3
• Superficial lacerations not involving the tongue tip 3
• Most tongue border injuries in children 3

Key evidence supporting conservative management: A retrospective study of 73 children showed that the secondary healing group recovered faster (median 6.2 days vs 13 days) and had significantly fewer complications (3.3% vs 25%) compared to the sutured group 3

Wound Closure Technique (When Indicated)

If suturing is necessary:

• Use 2% lidocaine for local anesthesia in cooperative patients 2
• Perform closure as soon as possible, ideally within 8-24 hours of injury 4
• Use absorbable sutures appropriate for oral mucosa 2

Post-Treatment Care

Wound care instructions:

• Apply occlusive dressing to clean wounds to promote healing (though challenging for intraoral wounds) 1
• Oral rinses with 0.1% chlorhexidine solution for 1 minute after repair and daily during healing 2
• Nonprescription oral cleansers (e.g., Listerine) may be used prophylactically 1
• Expected healing time is approximately 3-6 weeks 2

Dietary modifications:

• Avoid spicy, acidic, or hot foods that may cause discomfort 2
• Maintain regular oral hygiene to keep the wound clean 2

Follow-up monitoring:

• Remove any tongue jewelry during the healing process 2
• Monitor for signs of infection: redness, swelling, foul-smelling drainage, increased pain, or fever 1
• If infection develops, remove dressing, inspect wound, and obtain medical care 1

Special Considerations

Patients with bleeding disorders:

• May require additional hemostatic measures and hematology consultation 2

Self-inflicted trauma (repetitive):

• Consider protective oral appliance to cover maxillary teeth and prevent further injury 5
• This is particularly effective in children with behavioral causes of self-trauma 5

Traumatic granulomas:

• These benign, self-limiting lesions may develop after tongue trauma and can mimic malignancy 6, 7
• They typically resolve spontaneously without treatment, though may take weeks to months 6, 7
• Biopsy may be needed if the lesion persists or appears suspicious 7

Common Pitfalls to Avoid

• Do not use antiseptic solutions (povidone-iodine) for irrigation—they provide no benefit over tap water or saline 1
• Do not routinely suture all tongue lacerations—most heal well with secondary intention 3
• Do not apply topical antibiotics routinely to clean wounds—they do not improve outcomes 1
• Do not ignore wounds contaminated with saliva—these require urgent medical evaluation for infection risk 1
• Do not overlook the possibility of Ludwig angina (rapidly spreading oral cellulitis) as a complication, which requires airway management and systemic antibiotics 1