What is the recommended management for a tongue laceration?

Management of Tongue (Lingual) Lacerations

Most tongue lacerations heal excellently with conservative management alone, and suturing should be reserved only for large wounds (>2 cm), those with gaping edges at rest, through-and-through lacerations, or tip involvement. 1, 2

Initial Assessment and Decision-Making Algorithm

Assess the following characteristics to determine if suturing is needed:

• Wound length: Lacerations <2 cm can heal by secondary intention 2
• Gaping at rest: If wound edges separate when tongue is relaxed, consider repair 2
• Depth: Through-and-through lacerations (penetrating muscle layer) typically require suturing 1, 2
• Location: Tip lacerations benefit more from repair than lateral border injuries 2

The evidence strongly supports conservative management for most tongue lacerations. A systematic review of 142 cases found excellent healing regardless of management method, with no infections reported 1. A Swiss study demonstrated that conservatively managed wounds actually healed faster (median 6.2 days) with fewer complications (3.3%) compared to sutured wounds (13 days healing time, 25% complication rate) 2.

Conservative Management (First-Line for Most Lacerations)

For wounds <2 cm without gaping or tip involvement:

• Clean gently with warm saline rinses 3
• Apply white soft paraffin ointment or petroleum jelly to lips every 2 hours during acute phase to prevent drying 3
• Encourage gentle oral hygiene with warm saline rinses after meals 3
• Offer child's favorite drinks for oral irrigation to improve compliance 3
• Maintain good oral hygiene to prevent secondary infection 4

Surgical Repair Indications

Suture when ANY of the following are present:

• Laceration >2 cm in length 2
• Gaping wound edges with tongue at rest 2
• Through-and-through (full-thickness) laceration 1, 2
• Involvement of tongue tip 2
• Active bleeding not controlled by pressure 1

Anesthesia Options for Repair

Topical anesthetics (preferred for avoiding injection pain):

• LET (lidocaine-epinephrine-tetracaine): Apply to open wound for 10-20 minutes until edges blanch 5
  • Dose: 3 mL for children >17 kg; 0.175 mL/kg for <17 kg 5
  • Contraindications: Amide anesthetic allergy, gross contamination 5
  • Place cotton ball soaked with solution into wound and cover 5

Injectable lidocaine (if topical insufficient):

• Buffer with bicarbonate, warm before injection, use small-gauge needle, inject slowly to minimize pain 5
• Maximum dose without epinephrine: 1.5-2.0 mg/kg 3
• Buffered lidocaine remains stable for 30 days when pre-made 5

Alternative Closure Method

Tissue adhesive (2-octyl cyanoacrylate) can be used for tongue lacerations when parents refuse traditional suturing, though not FDA-approved for intraoral use 6. This provides painless closure and good cosmetic results, though evidence is limited to case reports 6.

Antibiotic Management

Do NOT prescribe prophylactic antibiotics for simple tongue lacerations. 3, 1

• Tongue lacerations in healthy individuals have very low infection risk 1
• No infections were reported in systematic review of 142 cases 1
• Antibiotics only indicated if signs of established infection develop 3

Pain Management

Acetaminophen 60 mg/kg/day divided into four doses provides adequate analgesia 3

Avoid topical anesthetics for intraoral use in young children due to accidental ingestion risk 3

Follow-Up and Warning Signs

Instruct caregivers to watch for:

• Fever 3
• Increasing pain, redness, or swelling beyond 24-48 hours 3
• Purulent discharge 3
• Difficulty eating or drinking due to worsening pain 3
• Wound dehiscence 3

Expected healing time:

• Conservative management: 6-7 days median 2
• Sutured wounds: 13 days median 2

Common Pitfalls to Avoid

• Do not over-suture: Most lacerations heal excellently without intervention, and suturing increases complication rates 1, 2
• Avoid adhesive dressings on or near lips: These cause additional trauma upon removal 3
• Do not assume all gaping wounds need repair: Only those gaping at rest require suturing 2
• Address contributing factors: Counsel about lip biting habits to prevent recurrence 4