What is the treatment for a bitten tongue?

Treatment of Bitten Tongue

For a bitten tongue, immediately irrigate the wound with copious amounts of water or sterile saline, apply direct pressure to control bleeding, avoid closing the wound, and administer prophylactic antibiotics (amoxicillin-clavulanate) along with tetanus prophylaxis if indicated. 1, 2

Immediate Wound Management

Irrigation and Cleaning

• Irrigate the wound with copious amounts of water or sterile normal saline to remove debris and reduce bacterial contamination 1, 2
• Thoroughly cleanse with sterile normal saline; avoid iodine or antibiotic-containing solutions for initial irrigation 2
• Remove only superficial debris—deeper debridement is usually unnecessary and may enlarge the wound 1, 2

Bleeding Control

• Apply direct digital pressure to the bleeding site as the primary method of hemostasis 3
• If persistent bleeding occurs despite pressure, consider topical tranexamic acid or an improvised clamp technique 3
• For severe traumatic macroglossia with ongoing trauma, muscle relaxants and a bite raiser may be necessary to prevent continued injury 4

Wound Closure Considerations

• Do not close infected wounds 1, 2
• For non-infected wounds seen early (<8 hours), consider approximation with Steri-Strips rather than sutures 1, 2
• Tongue wounds generally heal well by secondary intention due to the tongue's rich vascular supply 5

Antibiotic Prophylaxis

First-Line Therapy

• Amoxicillin-clavulanate is the recommended oral antibiotic for human bite wounds, including tongue bites 1, 2
  • Adult dose: 875/125 mg twice daily 1
  • Pediatric dose: 25 mg/kg/day of amoxicillin component in 2 divided doses 1

Alternative Oral Regimens (for penicillin allergy)

• Doxycycline 1, 2
• Penicillin VK plus dicloxacillin 1, 2
• Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) plus metronidazole or clindamycin for anaerobic coverage 1, 2

Agents to Avoid

• Do not use first-generation cephalosporins (cephalexin), penicillinase-resistant penicillins alone (dicloxacillin), macrolides (erythromycin), or clindamycin alone—these have poor activity against oral flora 1

Tetanus Prophylaxis

• Administer tetanus toxoid (0.5 mL intramuscularly) if the patient's status is outdated or unknown 1, 2
• Ensure tetanus prophylaxis is current for all bite wounds 1, 2

Follow-Up and Monitoring

• Follow up within 24 hours either by phone or office visit 2
• Elevate the head to reduce swelling and accelerate healing 1, 2
• Monitor for signs of infection: increased pain, swelling, fever, or purulent drainage 5
• Consider hospitalization if infection progresses despite appropriate antimicrobial therapy 2

Complications to Watch For

Airway Compromise

• Significant tongue swelling can potentially compromise the airway, particularly with deep lacerations or developing abscess 5
• Monitor for difficulty breathing, drooling, or inability to manage secretions 5

Deep Infections

• Tongue abscesses are rare due to rich vascular supply but require incision and drainage under general anesthesia if they develop 5
• Antibiotic coverage should include gram-positive and gram-negative anaerobes for suspected abscess 5

Extended Treatment for Complications

• For osteomyelitis (if mandible involvement): 4-6 weeks of antibiotics 2
• For septic arthritis (if temporomandibular joint involvement): 3-4 weeks of antibiotics 2

Common Pitfalls to Avoid

• Do not place objects in the mouth during active seizure if tongue biting occurs during a seizure—this causes additional trauma 1
• Avoid aggressive debridement that may enlarge the wound and impair healing 1, 2
• Do not use inadequate antibiotic coverage that misses anaerobic oral flora 1, 2
• Rabies prophylaxis is not indicated for human bites in the United States except in extraordinary circumstances 2