Tongue lacerations pose multiple technical challenges that can be addressed using the procedures described below.
Consider repairing lacerations of the tongue that are greater than 1 cm in length, that bisect the tongue, that are gaping wounds, or that have uncontrolled bleeding.
Do not repair amputations or partial amputations. These lacerations require a specialist, consult ENT
Injection of 1% lidocaine or lidocaine with epinephrine for wounds with uncontrolled bleeding. Alternatively, consider using a 4% topical lidocaine paste or an inferior alveolar nerve block. Performed properly, this nerve block will anesthetize the anterior two thirds of the tongue.
Drying the Field
Attach a Yankauer suction tip and tubing to compressed air to blow air onto the tongue and keep the field dry.
In a cooperative patient, the tongue can be grasped with 4×4 gauze between the thumb and index finger to reduce slipping. For anxious or non cooperative patients, consider placing a 0-silk suture deep into the middle of the anesthetized tongue to use as a retractor. Be sure to remove the retracting suture once the repair is complete.
Suture Placement and Knot Tying
Use simple interrupted sutures to repair most tongue wounds. Be sure to insert your needle half the depth of the tongue. Throw one to two extra knots and keep tails cut short to avoid patient tonguing at wound and causing dehiscence.