Tongue lacerations

Sir, at present there is conflicting literature regarding the appropriate management of tongue lacerations. Recommendations include suturing injuries located on the dorsum and lateral borders,¹ those that are greater than 2 cm in length or when haemostasis has not been achieved.² Deep tongue lacerations should be sutured in layers using resorbable sutures,³ and before excessive oedema occurs, ie within eight hours of injury, as delaying treatment beyond 24 hours would adversely affect the outcome.⁴

Lamell et al.⁵ recommend suturing tongue lacerations if they are gaping at rest, or if they involve the lateral border or if there is active haemorrhaging. He noted on examination that many of the tongue lacerations had well-approximated margins which stopped haemorrhaging, suggesting these injuries to be self-limiting. The application of pressure, cold and inactivity would also help achieve haemostasis.

I would like to describe a patient who suffered a gaping tongue laceration.

An 11-year-old child attended the Royal London Hospital emergency department shortly after falling onto concrete whilst playing football. He was managed conservatively and referred to the children's dental emergency clinic for a dental assessment the following day.

On extra-oral examination the patient had a swollen upper lip and superficial abrasions on his chin. Intra-orally, he had upper and lower fixed orthodontic appliances with gingival tearing palatal to the upper incisors. The occlusion was undisturbed and no fractures were noted on the teeth. He had a tongue laceration on the dorsal surface of the tongue which was 3.5 cm in length and gaping 1 cm at rest. This laceration had been treated conservatively. It had stopped bleeding on examination.

Special investigations on the upper incisors revealed a negative vitality test to ethyl chloride with no tenderness to percussion. Radiographic examination revealed no abnormalities. The patient was diagnosed with concussion relative to the upper central and lateral incisors and a lacerated tongue, which were both managed conservatively.

At the review appointment the patient had no complaints. The abrasions had healed and there were no changes to the dentition. The tongue healed extremely well with evidence of a minor scar. The upper incisors tested positively to thermal vitality testing.

This case highlights the need for careful assessment of tongue lacerations and leads to the question 'to suture or not to suture?' According to the criteria mentioned the tongue laceration should have been sutured as it was 'gaping at rest'. However, the examining clinician felt it was best not to suture this wound, and the photograph at the review appointment clearly shows excellent healing with minimal scarring. It is fair to say that clinicians should not be in a hurry to suture wounds as doing so does not improve the outcome nor reduce the morbidity associated with this type of injury. In particular to young children, behaviour management needs to be seriously considered as sedation or general anaesthesia may be required to place sutures.

Figure 1

Initial assessment: a gaping tongue laceration on the dorsal surface

Figure 2

Review appointment: excellent healing of the tongue with evidence of a minor scar