dental disorders
Tongue Trauma
Treatment of Tongue Trauma
Smoothing of sharp teeth or fillings Healing by secondary intention Sometimes suturing Bleeding has usually stopped by the time patients present. Isolated bleeding lacerations can often be compressed using a gauze pad. Extensively bleeding orofacial trauma should typically be evaluated and managed in the operating room with anesthesia and airway protection. The main consideration for the tongue injury is whether repair is required. This decision is taken more carefully than with skin lacerations of similar size because tongue repair requires a very cooperative patient or the use of sedation or anesthesia. Thus, a laceration that might be repaired on the arm might on the tongue be allowed to heal on its own. Fortunately, many tongue lacerations do not require surgical repair. Tongue lacerations that require repair include those in which there is Avulsion or partial amputation Persistent bleeding Problematic configurations (eg, the lacerations are bisecting, gaping, u-shaped, or include large flaps) Wound size>2 cm (smaller, if involving a split in the tip of the tongue) Superficial tongue lacerations due to a broken tooth or filling are treated by filing (smoothing) the tooth or repairing the filling. Healing of simple linear lacerations is facilitated by use of tooth guards or mouth protectors. Management of tongue lacerations follows the same principles as the treatment of any Treatment , with local anesthesia, cleansing, and repair. Even the most cooperative patients can rarely keep their mouth open and their tongue still. An assistant can grasp the tongue with gauze and hold it extended. Some clinicians place a strong stay suture through the anesthetized tip of the tongue and use that for traction and stabilization. Children typically require procedural sedation or sometimes anesthesia. is typically acceptable. Lacerations of the anterior two thirds of the tongue can be anesthetized with a nerve block (see also How To Do an Inferior Alveolar Nerve Block . Topical antiseptics (eg, povidone iodine) are unnecessary. Irrigate the wound with a modest amount (eg,<100 mL) of normal saline solution, taking care to avoid aspiration by the patient. Remove all foreign material; it is impossible and unnecessary to keep the wound free of saliva during the repair. Excise any clearly devitalized tissue. Then close the wound using 3-0 or 4-0 absorbable suture material. Absorbable suture is softer (and thus more comfortable inside the mouth) than synthetic nonabsorbable suture and does not need to be removed. Patients should follow a soft diet for several days and rinse out their mouth after eating or drinking. All but the most minor wounds should be checked in about 48 hours. Antibiotics are usually unnecessary unless the wound is contaminated (based on nature of the injury, from an exogenous source) or the patient is significantly medically compromised (has poorly controlled diabetes mellitus or other immune-compromising condition). The benefit of antibiotic use for most tongue lacerations in healthy patients is limited. If antibiotics are deemed necessary, consider penicillin,amoxicillin, orclindamycin(in a patient who is allergic to penicillin). 