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Clinical Procedures > Soft Tissue Procedures
Complex Laceration, Tongue
Article Last Updated: May 22, 2008
AUTHOR AND EDITOR INFORMATION
Section 1 of 13  
Author: Gretchen S Lent, MD, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center
Coauthor(s):
Neel Kumar, MD, Chief Resident, Department of Emergency Medicine, Albert Einstein College of Medicine, Jacobi and Montefiore Medical Centers
Editors: Luis M Lovato, MD, Assistant Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine; Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Author and Editor Disclosure
Synonyms and related keywords:
tongue laceration, complex laceration, tongue injury, tongue bite, oral laceration, tongue laceration repair, tongue injury repair, tongue suture, tongue amputation, tongue flap, flap excision, tongue suturing
The tongue is enveloped by mucosa and contains glands, sensory organs, and 4 pairs of extrinsic muscles. It is essential for several important functions, including normal articulation of the jaw, manipulation of food, swallowing, and the production of normal speech.
Tongue anatomy in cross-section. The epithelial surfaces comprise the mucosa.
Injuries to the tongue, mainly lacerations, are often treated in the emergency department or other acute care settings. A tongue laceration is often the result of a fall, seizure, or other blunt force mechanism.1 Because of the tongue’s generous blood supply, most tongue lacerations do not become infected and heal well without repair. However, repair is required when the injury has certain characteristics (see Indications). The goals of laceration repair of the tongue are to attain adequate closure, minimize complications, preserve mobility, and optimize articulation and deglutition.
For more information on traumatic wounds, see the Medscape Wound Management Resource Center and Trauma Resource Center.
Characteristics of tongue lacerations that require repair include the following2, 3, 4:
- Bisecting wounds
- Large flaps
- Actively bleeding wounds
- Wounds larger than 1 cm
- Gaping wounds
- U-shaped lacerations
- Avulsion or amputation injuries (The tongue may be primarily closed if the defect is less than 30%.)
- Most tongue lacerations do not require sutures.
- Small flaps may be simply excised.
- Tongue lacerations in children are known to heal well without intervention.5
- Simple linear lacerations, especially if centrally located, heal with minimal risk of infection.
- Amputations or avulsions of more than 30% require a flap procedure, which should be performed by a specialist.6, 7
Any of the following anesthesia techniques may be employed:
Personal protective equipment - Gloves
- Sterile gloves
- Face shield
- Gown
Anesthesia equipment
- Lidocaine
- Syringe, 10 mL
- Needle, 27 gauge (ga)
- Needle, 18 ga
- Topical anesthetic
Irrigation equipment
- Sterile saline or water
- Syringe or irrigation device
- Splash shield
- Basin
Suture material
- Absorbable sutures (eg, nylon, Ethilon, gut, chromic gut), 4-0
- Suture tray
- Suture kit
- Towel clip
Other equipment
- Side mouth gag (eg, Denhardt, Dingman)
- Bite block
- Towel clip
- Gauze, 4 X 4 in
- The supine position is preferable for most repairs.
- The patient may sit in an ENT chair, if necessary.
Preparation - Once the patient is anesthetized, inspect the wound carefully.
- Some through-and-through lacerations may not be obvious without gentle probing.
- Always check for chipped, missing, or mobile teeth in mouth injuries. Tooth fragments may be lodged inside the wound and, if not removed, may serve as a nidus for infection.
- Intraoral wounds are prone to considerable contamination, and thorough irrigation is necessary.
- The major difficulty in closing a tongue laceration is maintaining control of the area being sutured. To stabilize and hold in protrusion for repair, the tip of the tongue can be grasped with gauze or a towel clip or punctured and withdrawn with a large suture.
- A bite block may be used to protect both the patient and physician, as necessary.
Suturing - Through-and-through lacerations may be closed in 1-3 layers.
- As long as the muscular layer is closed, bleeding is sufficiently controlled, motor function is returned, and the mucosal layers heal rapidly.
Bisected tongue.
Closure of the superior mucosa of a bisected tongue.
Closure of the lateral aspect of the tongue.
Closure of the superior mucosa of a tongue laceration not involving the lateral margin. - Three-layer technique
- Using 4-0 absorbable sutures, first close the muscular mucosa.
- The inferior mucosa is then sutured.
- The repair is then extended up and around the lateral aspect of the tongue to close the superior mucosa.
Cross-section: Three-layer closure technique.
Closure of the muscular mucosa as the first step of a three-layer technique.
- Two-layer technique
- Use one stitch to approximate half the thickness of the tongue superiorly.
- Use another stitch to approximate half the thickness inferiorly.
- Close the edges of the tongue.
- Sutures do not have to be buried.
Cross-section: Two-layer closure technique.
- One-layer technique
- Some suggest using a deep absorbable suture to close only the muscular layer, leaving the other layers open to heal without sutures.
- This technique is successful because of the rapidly healing superficial mucosa.
Cross-section: One-layer closure technique.
- The frequent movements of the tongue often untie the sutures.
- This can be avoided by burying the stitches or tying many knots.
- Avoid nylon in the mouth and tongue.
Aftercare - After repair, the patient should eat a soft diet for 2-3 days.
- Daily dilute peroxide mouth rinses should be used.
- Healing occurs very rapidly.
- Update the patient’s tetanus vaccination, if necessary.
- The use of prophylactic antibiotics for tongue injury is controversial, but they should be used in any contaminated wound.8 For more information, see eMedicine article Human Bite Infections.
- Infection
- Impaired articulation
- Impaired deglutition
The authors and editors of eMedicine gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article.
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Tongue anatomy in cross-section. The epithelial surfaces comprise the mucosa. |
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Cross-section: Three-layer closure technique. |
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Cross-section: Two-layer closure technique. |
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Cross-section: One-layer closure technique. |
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Closure of the superior mucosa of a bisected tongue. |
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| Media file 8:
Closure of the superior mucosa of a tongue laceration not involving the lateral margin. |
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| Media file 9:
Closure of the muscular mucosa as the first step of a three-layer technique. |
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Complex Laceration, Tongue excerpt Article Last Updated: May 22, 2008
Topic originally published: May 22, 2008
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