Overview of Tongue Laceration
The tongue is a muscle we use to speak and enjoy food by tasting, chewing, and swallowing. This means any injury to the tongue can severely affect a person’s day-to-day life. Tongue cut or tears can happen due to a lot of different reasons. These could include having a seizure, hurting oneself, being hit in the face, or even from a child being abused. There have been cases where people have gotten tongue injuries during certain types of therapy, like electroconvulsive therapy. Even using electronic cigarettes has caused some people to hurt their tongues because of explosions.
However, whether or not all tongue cuts or tears should be treated with medical procedures or left to heal naturally is currently debated among doctors.
Anatomy and Physiology of Tongue Laceration
Tongue cuts are most often found on the front top surface of the tongue. They can also occur in the middle of the tongue’s top and on the underside of the tongue’s front. Cuts on the back of the tongue are less common. If a piece from the tip or side of the tongue is completely lost, it can’t be stitched back on, but the good news is, this is unlikely to cause any lasting damage.
Usually, your tongue will naturally grow and fill in any missing areas with time. However, if the base of your tongue is injured, it could be more difficult to deal with because of a nerve called the hypoglossal nerve that is located there. This nerve controls tongue movements, so an injury could potentially lead to difficulties in speech or swallowing.
Why do People Need Tongue Laceration
If you have a cut on your tongue, whether it needs to be stitched up depends on the size of the cut or if the wound is wide open. Doctors best check the cut when the tongue is resting inside the mouth, which is its usual position, rather than sticking out. Certain bigger or more complex cuts might need to be repaired. These might include cuts that result in flaps of tissue, are actively bleeding, or go all the way through the tongue.
Smaller cuts or tears where a piece of tongue has been ripped off might not always need treatment. This is because the tongue has a unique ability to expand or “bulk up”. The tongue can fill up the wounded area so well that you can’t even tell there was an injury or missing piece to begin with.
When a Person Should Avoid Tongue Laceration
There are times when a wound cannot be repaired immediately in the emergency department. One of these situations is if there’s been a considerable delay since the injury occurred. In those cases, the wound is usually allowed to heal on its own. As for tongue amputation, it’s a very serious condition that requires special care, and it can’t be managed alone by general doctors in the emergency or primary care settings.
Equipment used for Tongue Laceration
The following things may be needed during a medical procedure:
* A suction device, which can remove fluids from the body or the surgical area.
* Gauze, a type of cloth used to absorb blood and other fluids and to prevent infection.
* A laceration repair kit. This includes instruments like a needle driver (for holding sutures) and scissors.
* Anesthetic drugs like Lidocaine, LET, or bupivacaine, with or without epinephrine, which are used to numb the area where the procedure will take place. These drugs can be applied directly on the skin (topical), injected into the tissue around the procedure site (local), or injected to block signals from a group of nerves (block).
* Normal saline, a salt water solution often used for cleaning wounds.
* Needles and syringes for injecting medications or anesthetics.
* Absorbable sutures, which are special threads used to close wounds. They’re made from materials that your body can safely break down, so they don’t have to be removed later. The numbers (3-0, 4-0) refer to the thickness of the suture, with larger numbers being thinner.
* A tongue depressor, which is used to hold the tongue down to allow a better view of the mouth or throat.
* A bite block, a device that helps patients keep their mouth open during a procedure.
In addition, if a child is undergoing a procedure, they might also be given sedatives or pain medication sprayed into the nose (intranasal) to help them stay calm and comfortable during the procedure.
Who is needed to perform Tongue Laceration?
The medical team that might be working with you in case of an emergency could be quite varied. This team may consist of an emergency medicine doctor, who is the expert in dealing with sudden and urgent illnesses or injuries. If needed, there can also be an advanced practice provider. This is a healthcare professional who has done additional training to provide healthcare services above and beyond those usually given by nurses.
If the problem is related to your mouth, jaw or face, an oral maxillofacial surgeon may be involved. This specialist is trained in surgery to correct a wide range of diseases, injuries and defects in the head, neck, face, jaws. If the injury has to do with your ear, nose or throat, an ear nose and throat specialist might be there to help as well. This doctor has special training in managing diseases of the ears, nose and nasal passage sinuses, larynx (voice box), oral cavity and upper pharynx (mouth and throat).
Also, other specialist doctors might be there depending on your unique health situation and needs. Lastly, we can’t forget the vital role that nursing staff plays. They ensure the smooth operation of all medical procedures and provide hands-on patient care. The exact mix of healthcare professionals involved depends on how severe the injury is, who the patient is, and what resources are available.
Preparing for Tongue Laceration
If you have a wound that needs to be treated, your doctor will first look carefully at the wound. They will check for any foreign objects that might be stuck in the wound, like broken pieces of teeth. Once they are sure there’s nothing in the wound, they’ll cleanse it thoroughly and make sure it’s not bleeding.
To make you comfortable during the procedure, your doctor will give you medication to numb the pain. This might be local anesthesia (which makes the area around the wound numb) or in severe cases, you might be put to sleep with general anesthesia in the operating room. If your wound is on your tongue, special types of numbing techniques like an inferior alveolar nerve block or lingual nerve block can be used. These essentially numb the front two-thirds of the tongue.
Different methods can be used to handle your tongue during the treatment. Your doctor might use something like a piece of gauze to hold your tongue out of your mouth. Alternatively, they might thread a silk stitch through the tongue. The loose ends of this stitch can then be held to move the tongue around during the treatment.
How is Tongue Laceration performed
Large cuts might need deep stitches or a layer-by-layer repair to relieve muscle pressure and allow the edges to come together. This method can also help prevent a blood clot from forming under the skin. The thread used for stitching requires strength as it will experience regular movement and pressure as part of the tongue’s normal function. Several studies have shown that ‘vicryl’ and ‘chromic gut’ (types of suture materials) are commonly used for this. The stitches were placed to join the edges of the cut, but not too tightly, to allow for swelling and prevent damage to the tissue due to lack of blood flow.
Besides stitches, there’s a case where a special medical glue called ‘dermabond’ was used to close a wound in a seven-year-old child. Usually, dermabond isn’t approved for use inside the mouth, but it was used in this case because the child’s mother didn’t want her child to have sedation or local anesthetic. A piece of gauze was used to hold and dry the child’s tongue, and pressurized air was used to dry the tongue just before applying the dermabond.
When the wound was checked the next day and after two weeks, the dermabond had stayed in place and helped to heal the wound nicely. The cut mentioned above was located on the top of the tongue’s surface and didn’t involve the edge of the tongue.
Possible Complications of Tongue Laceration
If you get a cut or tear on your tongue that’s stitched up, sometimes the non-dissolving thread used (non-absorbable suture) can cause a small bump or lump to form. This happens because your body reacts to the foreign material, similar to how it might respond to a splinter. Just like with any wound that heals, there’s also a chance for a visible scar. Even if the tongue heals on its own (secondary intention healing), a scar could still develop.
Doctors argue about the risk of infection with tongue cuts and whether to use antibiotics or not. There aren’t clear instructions yet for these situations, so the final decision is usually left to the doctor. They might consider giving preventative antibiotics if the patient has a weak immune system, the wound is dirty, or the treatment was delayed for some reason. The antibiotics they choose should be effective against certain types of bacteria, specifically gram-positive and anaerobic bacteria.
Besides infection and scarring, other complications might include swelling of the tongue or impaired speech and swallowing. In severe cases, there can even be difficulty breathing if the tongue swells too much or if there’s a lot of bleeding.
What Else Should I Know About Tongue Laceration?
Tongue cuts can happen to anyone, from any kind of injury, which makes it hard to have a standard treatment. Just like any skin cut, when you cut your tongue, doctors need to check how serious it is, whether it’s dirty, and if there’s anything that would get in the way of healing. It’s pretty controversial among doctors whether to stitch up the tongue cut or let it heal naturally.
There hasn’t been a large study to compare these two approaches yet, so doctors typically decide on a case-by-case basis. There are different ways to treat tongue cuts like using stitches or a medical glue called dermabond, but sometimes, the cuts can heal well even with no treatment at all. The Zurich Tongue Scheme is a guide that gives doctors a better understanding of when to treat tongue cuts, how to treat them, and what common issues might come up when they’re taking care of a patient with a tongue cut.
