Tongue lacerations can be tricky business: slimy, squirmy, and exquisitely sensitive…patients typically have a tough time handling these repairs.
This post discusses indications for tongue laceration repair, principles of repair, and tips to help your next repair go more smoothly. The accompanying video below describes the essentials of this post, in three minutes. But if you prefer reading…read on!
Typically accepted indications for repair of a tongue laceration include:
- Lacerations > 1cm
- Lacerations that bisect the tongue
- Gaping wounds
- Uncontrolled bleeding
- Your ideal suture for this repair is a 4-0 or 5-0 chronic gut.
- Most lacerations of the tongue are best repaired using simple interrupted suture placement. Remember, the tongue is a muscle, so wound edges retract and the wound may appear more complex than it really is.
- Your ideal suture depth is about 1/2 the depth of the tongue itself (if you don’t think your suture needs to be driven down this far, reconsider if you actually need them!
Tips & Tricks
- As most tongue lacerations are relatively small and can be repaired quickly, short acting local anesthetic is often your best bet for getting it numb. 1% lidocaine is an excellent choice. If uncontrolled bleeding is an issue, use 1% lidocaine with epinephrine.
- 4% topical lidocaine paste is also an option. Sometimes this alone can provide adequate anesthesia for repair. At the very least, it can make susequent injection of a sensitive area more tolerable, so it is a good first step.
- For a more elegant approach, consider the inferior alveolar nerve block [link to follow]. This block commonly used in dentistry provides effective anesthesia to not only the anterior two thirds of the tongue, but a host of other mandibular structures.
- Tongue protrusion:
- One of the trickiest parts of doing these repairs is keeping the patient’s tongue out of his/her mouth to keep your field of exposure. In the cooperative patient, a few 4×4 gauze pads can be used to create enough friction to hold the tongue. Typically an assistant will hold these pads between the thumb and index finger.
- Another option for a very jumpy patient (when you don’t want extra fingers anywhere near the field) is to throw a single 0-silk suture through the center of the (anesthetized) tongue, then use this for retraction. It can be removed at the conclusion of the repair.
- Tricks of the trade
- Keep the field dry. A wet field constantly bathed in saliva & secretions is sure to make your repair trickier. Rather than constantly blotting with gauze pads, consider this trick: take a Yankauer suction tip and tubing and attach it to compressed air. You’ve created a mini “blow dryer” which an assistant can hold in your field to keep the area dry and tidy as you complete your repair.
- While you might not typically think of tissue adhesive glue as your go-to for tongue lacerations, there is a precedent for this. You can read an abridged version of the case report as well as a few other things you didn’t know about skin glue here. You would need to dry the tongue well so the blow dryer trick comes in handy here. The reality though: I’ve tried this a few times with pretty limited success. The glue has a strong tendency to dislodge prematurely. Do be reassured that there is little risk to the patient of accidental ingestion of 2-octyl-cyanoacrylate, if you decide to try it!
- Consider tying an extra knot or two to ensure that the suture stays in place, and keep the tails on the sutures short. You know that feeling of having something stuck in between your teeth, and the impossibility of keeping your tongue away from it? Consciously or unconsciously, that foreign body sensation is going to keep that patient’s tongue twiddling at the wound–which may lead to premature dehiscence–so make sure your sutures are well-secured.