From the Guidelines
For a small laceration of the tongue with swelling, the best treatment involves applying a topical anaesthetic preparation, such as viscous lidocaine 2%, 15 mL per application, to manage pain and discomfort. This approach is supported by the UK guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016 1.
To reduce bacterial colonization of the mucosa, an antiseptic oral rinse, such as 1.5% hydrogen peroxide mouthwash (Peroxyl mouthwash, 10 mL twice daily) or 0.2% chlorhexidine digluconate mouthwash (Corsodyl mouthwash, 10 mL twice daily), should be used twice daily 1.
- Key considerations include:
- Using a topical corticosteroid four times daily, such as betamethasone sodium phosphate 0.5 mg in 10 mL water as a 3-min rinse-and-spit preparation, to reduce inflammation
- Applying a more potent preparation, clobetasol propionate 0.05%, mixed in equal amounts with Orabase, directly to the affected area daily during the acute phase
- Monitoring for signs of secondary infection, such as bacterial or candidal infection, and treating accordingly with agents like nystatin oral suspension or miconazole oral gel 1
It is essential to note that the treatment should prioritize reducing pain, inflammation, and the risk of infection, while also monitoring for any signs of complications that may require further medical attention.
From the Research
Treatment of Small Laceration of Tongue with Swelling
- The treatment of small lacerations, including those on the tongue, typically involves wound closure and management to prevent infection and promote healing 2.
- For small lacerations of the tongue with swelling, maintaining a moist wound environment with occlusive dressings is important, as it can aid in the healing process 2.
- Topical anesthetics may be used to manage pain, especially in select populations, but their application should be considered on a case-by-case basis 2.
- The use of antibiotics should be reserved for high-risk wounds, such as those with significant contamination, involvement of deeper structures, or in patients with comorbidities like diabetes or immunodeficiency 2, 3.
- There is limited evidence specifically addressing the treatment of tongue lacerations with swelling, but general principles of wound care, including irrigation, debridement (if necessary), and closure, can be applied 2.
- Novel approaches such as the use of tissue adhesives or atraumatic closure devices may offer painless and rapid closure options for some lacerations, but their suitability for tongue lacerations would depend on the specific circumstances of the injury 2.
Considerations for Antibiotic Use
- The decision to use prophylactic antibiotics in the treatment of lacerations, including those on the tongue, should be based on the risk of infection, considering factors such as the extent of contamination, the presence of comorbidities, and the depth of the wound 3.
- Studies on surgical wounds healing by secondary intention suggest that the evidence for the use of antiseptics and antibiotics is generally of low to moderate quality, and there is no robust evidence supporting the use of specific preparations over others for preventing infection in such wounds 4.
- For tongue lacerations, as with other wounds, the primary goal is to prevent infection and promote healing, but the specific approach to antibiotic use should be tailored to the individual case, taking into account the risk factors for infection 2, 3, 4.