Tongue injury may result from
Accidental bites
Sharp or broken fillings or teeth
Blunt trauma
Penetrating trauma
Accidental bites may occur during normal chewing, during seizures, or from a blow to the jaw (eg, from a fall, altercation, vehicle crash) when the tongue is between the teeth. Sharp or broken fillings or teeth may cause significant damage.
Tongue injury from major blunt facial trauma usually involves significant damage to adjacent structures.
Penetrating facial trauma includes gunshots and severe stabs or impalements. Involvement of the tongue implies involvement of other structures of the lower face. Major penetrating facial injuries bleed heavily and can obstruct the airway due to aspiration and/or edema of the tongue and mouth floor.
Most tongue injuries are relatively minor, and the rich blood supply to the tongue ensures that they heal quickly without becoming infected. However, this rich blood supply makes achieving hemostasis in major injuries challenging.
(See also Approach to the Trauma Patient.)
Diagnosis of Tongue Trauma
The diagnosis of an isolated tongue injury is typically obvious by inspection. With major trauma, airway establishment and control, hemorrhage control, and identification of significant vascular injury precede evaluation for injuries to the mandible, midface, and teeth.
Treatment of Tongue Trauma
Smoothing of sharp teeth or fillings
Healing by secondary intention
Sometimes suturing
Bleeding has usually stopped by the time patients present. Isolated bleeding lacerations can often be compressed using a gauze pad. Extensively bleeding orofacial trauma should typically be evaluated and managed in the operating room with anesthesia and airway protection.
The main consideration for the tongue injury is whether repair is required. This decision is taken more carefully than with skin lacerations of similar size because tongue repair requires a very cooperative patient or the use of sedation or anesthesia. Thus, a laceration that might be repaired on the arm might on the tongue be allowed to heal on its own.
Fortunately, many tongue lacerations do not require surgical repair.
Tongue lacerations that require repair include those in which there is
Avulsion or partial amputation
Persistent bleeding
Problematic configurations (eg, the lacerations are bisecting, gaping, u-shaped, or include large flaps)
Wound size > 2 cm (smaller, if involving a split in the tip of the tongue)
Nonsurgical treatment
Superficial tongue lacerations due to a broken tooth or filling are treated by filing (smoothing) the tooth or repairing the filling. Healing of simple linear lacerations is facilitated by use of tooth guards or mouth protectors.
Surgical treatment
Management of tongue lacerations follows the same principles as the treatment of any laceration, with local anesthesia, cleansing, and repair.
Even the most cooperative patients can rarely keep their mouth open and their tongue still. An assistant can grasp the tongue with gauze and hold it extended. Some clinicians place a strong stay suture through the anesthetized tip of the tongue and use that for traction and stabilization. Children typically require procedural sedation or sometimes anesthesia.
How To Do an Inferior Alveolar Nerve Block). Topical antiseptics (eg, povidone iodine) are unnecessary.
Irrigate the wound with a modest amount (eg, < 100 mL) of normal saline solution, taking care to avoid aspiration by the patient. Remove all foreign material; it is impossible and unnecessary to keep the wound free of saliva during the repair.
Excise any clearly devitalized tissue. Then close the wound using 3-0 or 4-0 absorbable suture material. Absorbable suture is softer (and thus more comfortable inside the mouth) than synthetic nonabsorbable suture and does not need to be removed.
