Kids are gravitationally challenged and fall all the time! This often leads to simple bumps, bruises and minor injuries. Occasionally, kids present to the ED with tongue lacerations. - The most common location is the anterior portion of the tongue.
- Lacerations on the lateral side of the tongue are usually associated with seizures
- When you find one laceration, always look for another.
Management:
- Don’t get distracted by the obvious tongue injury.
- It’s a trauma, so assess the airway
- The airway can be compromised by:
o Bleeding
o Tongue swelling
o Retained foreign bodies:
- Fragments of teeth
- Fragments of other objects
- To Close or Not To Close?
o Primary repair in the ED should be considered for tongue lacerations with the following characteristics:
- Bisect the tongue extending through the free edge – creating the “snake” look
- Have large mobile flaps or U-shaped defects (>1-2cm)
- Gaping at rest
- Won’t stop bleeding
Repair:
- You’ll need to get everything together beforehand, and consider providing sedation. Local anesthesia can be provided with 4% lidocaine gel on gauze applied for 5 minutes, 1% lidocaine injected into the tongue, or an inferior alveolar nerve block which will block the lingual nerve and the anterior 2/3 of the tongue.
- You also need to control the tongue and keep it protruded. This can be accomplished by grabbing the tip with forceps, or by placing a large (2-0 nylon) suture through the tip.
- Copious irrigation without drowning the patient is important.
- Length of the procedure is an issue for younger/sedated patients, but you also want the sutures to stay in place as they can become untied due to the normal movements of the tongue. Therefore, it is important to use absorbable sutures (4-0 chromic gut) and bury the knots in the tongue itself if possible.
- The patient should be discharged on a soft diet for 2-3 days, and encouraged to do peroxide/chlorhexidine mouth rinses after eating. Specific follow-up is only necessary for poor healing wounds, or those that lead to problems with speech or eating. Antibiotics are not necessary.
Watch this short video showing a tongue laceration repair in a child under procedural sedation:
https://www.youtube.com/watch?v=6sbIrVIDzZk
Sources:
Pediatric EM morsels
PEMblog briefs