Tongue injury may result from
Sharp or broken fillings or teeth
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. 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 blunt 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.
Diagnosis of isolated tongue injury is typically obvious by inspection. With major trauma, airway establishment and control Airway Establishment and Control Airway management consists of Clearing the upper airway Maintaining an open air passage with a mechanical device Sometimes assisting respirations (See also Overview of Respiratory Arrest.) read more , hemorrhage control, and identification of significant vascular injury precede evaluation for injuries to the mandible, midface, and teeth. (See also Approach to the Trauma Patient Approach to the Trauma Patient Injury is the number one cause of death for people aged 1 to 44. In the US, there were 243,039 trauma deaths in 2017, about 70% being accidental. Of intentional injury deaths, more than 70%... read more .)
Treatment of Tongue Trauma
Smoothing of sharp teeth or fillings
Healing by secondary intent
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
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)
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.
Management of tongue lacerations follows the same principles as the treatment of any laceration Treatment Lacerations are tears in soft body tissue. Care of lacerations Enables prompt healing Minimizes risk of infection Optimizes cosmetic results read more , 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.
For local anesthesia, infiltration with 1% lidocaine (with or without epinephrine) is typically acceptable. Lacerations of the anterior two-thirds of the tongue can be anesthetized with an inferior alveolar nerve block. Topical antiseptics (eg, povidone iodine) are unnecessary. (See also How To Do an Inferior Alveolar Nerve Block How To Do an Inferior Alveolar Nerve Block An inferior alveolar nerve block, the most common dental nerve block, anesthetizes the ipsilateral hemi-mandible (including teeth and bone), as well as the lateral (buccal) mucosa over the lower... read more .)
Irrigate the wound with a modest amount (eg, < 100 mL) of normal saline solution, taking care to avoid aspiration. Remove all foreign material, but 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.
Patients should follow a soft diet for several days and rinse out their mouth after eating or drinking. All but the most minor wounds should be checked in about 48 hours. Antibiotics are usually unnecessary unless the wound is contaminated (based on nature of the injury) or the patient is significantly medically compromised (has poorly controlled diabetes mellitus or other immune-compromising condition). The benefit of antibiotic use for most tongue lacerations in healthy patients is limited. If antibiotics are deemed necessary, consider penicillin, amoxicillin, or clindamycin (in a patient who is allergic to penicillin).
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