A 3 year old male was jumping in his bed. He jumped one time too many and landed on his dresser, hitting his chin and biting his tongue in the process. He then ran downstairs and bloodied the carpet. Mom grabbed a towel sopped up some mouth blood, then scooped him up and threw him to the ED.

On exam he is protecting his airway, the bleeding has stopped, and you see the following:

A lacerated tongue

The bleeding is well controlled, he is only in mild pain, and it does not go through the tongue completely. He had just eaten some chicken nuggets, so he’s not remotely NPO. What do you do?

Which tongue lacerations do I need to repair?

The short answer. Not many of them. Tongue lacerations are generally the result of trauma and seizures. The former being much more common in the Peds ED. Seizures are more likely to be associated with lateral lacerations. The tongue has a great blood supply and is one of the fastest healing parts of the body (less than 3-5 days in many cases). The risk of infection is also incredibly low. You should repair those that cause problems with breathing, speech and/or gustation/swallowing:

  • Bisect the tongue extending through the free edge – creating the “snake” look
  • Have large mobile flaps or U-shaped defects (>1-2cm)
  • Won’t stop bleeding
  • Are avulsion or amputation injuries – which may require a surgeon (ENT, OMFS etc.) if complex. Here is a diagram of how an avulsed tongue should be sewn – Easier said than done…

Here are some examples of tongues that may or may not need a repair – click on the box above each picture to see the answer:

[toggle_box] [toggle_item title=”Does this tongue laceration need to be repaired?” active=”false”]YES[/toggle_item] [/toggle_box]
Tongue lac #1

Tongue lac #1

[toggle_box] [toggle_item title=”Does this tongue laceration need to be repaired?” active=”false”]NO[/toggle_item] [/toggle_box]
Tongue Lac #2

Tongue Lac #2

[toggle_box] [toggle_item title=”Does this tongue laceration need to be repaired?” active=”false”]NO[/toggle_item] [/toggle_box]