II. Management: Laceration Repair

  1. See Laceration
  2. Indications
    1. Laceration >1-2 cm long
    2. Lacerations creating deformity or bisect the Tongue (e.g. snake Tongue)
    3. Gaping open wounds
    4. Uncontrolled bleeding
  3. Preparation
    1. Suction device
    2. Bite block
    3. Absorbable Suture (3-0, 4-0 or 5-0): Chromic Gut or Vicryl
    4. Tissue Adhesive (e.g. Dermabond) has been used in case reports in children
      1. Tissue Adhesive is not FDA approved for mucosa or oral use
      2. Hold gauze in area to keep mucosa dry
      3. Apply pressurized air (e.g. oxygen via Nasal Cannula prongs) while drying
      4. Kazzi (2013) J Emerg Med 45(6):846-8 +PMID: 23827167 [PubMed]
  4. Anesthesia Options
    1. Local injection Lidocaine 1% with Epinephrine
    2. Topical 4% Lidocaine paste or cream (e.g. L.M.X. or ELA-MAX)
    3. Inferior alveolar Nerve Block or lingual block (anesthetizes the anterior two thirds of Tongue)
  5. Technique
    1. Assistant holds the Tongue out
      1. Grasp between thumb and index finger 4x4 gauze that is folded over the Tongue edge
    2. Simple interrupted Suture with depth 50% of overall Tongue depth
    3. Layered closure may be needed in deep Lacerations, and in the prevention of Hematoma formation

III. Management: Bleeding Tongue Wound

  1. Precautions
    1. Heavy Tongue bleeding may result in airway compromise
  2. Home Treatment
    1. Apply ice to the area
    2. Swish and spit ice water
    3. Tea Bag Technique for Hemostasis
      1. Black tea bags are preferred (highest tannin concentration)
      2. Moisten tea bag
        1. May steep briefly in cold water
        2. If steeped in hot water, allow tea bag to cool
      3. Patient should press the teabag against the wound for 15 minutes without removing the tea bag
        1. Pressure against the tea bag releases additional tannins
        2. If bleeding recurs after removing the tea bag, repeat a second time for an additional 15 minutes
  3. Medical Interventions
    1. Topical Tranexamic Acid or TXA (preferred first-line measure of mild to moderate bleeding)
      1. See Tranexamic Acid for swish and gargle method used in post-Tonsillectomy bleeding
      2. Soak a 4x4 gauze in Tranexamic Acid solution (preprepared or a 500 mg tablet dissolved in water)
      3. Apply the soaked gauze to the Tongue bleeding site for 30 minutes continuously
    2. Topical Thrombin
      1. Consider as first-line measure in patients on Warfarin
      2. Use the same 4x4 method as for TXA topical application
    3. Lidocaine with Epinephrine Injection
      1. Inject the site of bleeding
      2. Consider an inferior alveolar Nerve Block before injecting the Tongue
    4. Other measures
      1. Cautery
      2. Tongue Laceration repair (see above)

IV. Resources

  1. Tongue Laceration Repair (Stat Pearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK540967/
  2. Tongue Laceration Repair (Closing the Gap)
    1. https://lacerationrepair.com/techniques/anatomic-regions/tongue-lacerations/

V. References

  1. Warrington (2022) Crit Dec Emerg Med 36(11): 20

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