Tongue lacerations in children: to suture or not?

Michelle Seiler; Sandra Letizia Massaro; Georg Staubli; Clemens Schiestl

doi:10.4414/smw.2018.14683

Original article

Vol. 148 No. 4344 (2018)

Tongue lacerations in children: to suture or not?

Michelle Seiler
Sandra Letizia Massaro
Georg Staubli
Clemens Schiestl

DOI: https://doi.org/10.4414/smw.2018.14683
Cite this as:: Swiss Med Wkly. 2018;148:w14683
Published: 28.10.2018

Summary

AIMS OF THE STUDY

Tongue lacerations are common in children, occurring mostly from falls or sports injuries. Optimal treatment of tongue lacerations is a challenge for paediatricians due to contradictory recommendations and a lack of current guidelines. It remains unclear which tongue lacerations should be sutured and which would benefit from spontaneous healing, which is a promising alternative. In recent years, the treatment of choice in our paediatric emergency department (ED) has shifted from generally suturing the wounds to more frequently advising secondary wound healing. The aim of this study was to analyse tongue lacerations treated at our ED in order to develop guidance for the optimal management of tongue lacerations in children.

METHODS

This retrospective study was conducted to assess tongue lacerations at the ED of a University Children’s Hospital Zurich from January 2010 to August 2015. All families were contacted for informed consent and photo documentation of the healed tongue. Clinical records of all the patients included were reviewed and different variables were defined and analysed.

RESULTS

A total of 73 children with tongue lacerations were included (75.3% boys, mean age ± standard deviation 4.0 ± 2.6 years). The mean size of the lacerations was 12.4 ± 8.3 mm, with affected tongue borders in 51 cases (69.9%) and a through-and-through laceration in 23 patients (31.5%). A primary wound closure was performed in 12 children (16.4%). These wounds were significantly larger than those of the secondary wound healing group (21 ± 10 mm compared to 10.8 ± 6.8 mm), presented gaping wound edges with the tongue at rest more frequently (91.7% compared to 32.8%), and showed through-and-through lacerations more often (91.7% compared to 19.7%). The group with wound suturing needed longer to recover (median 13 days compared to 6.2 days) and had a higher rate of complications (25 vs 3.3%).

CONCLUSIONS

Suturing is not required in gaping tongue lacerations less than 2 cm long that do not involve the tip of the tongue. The Zurich Tongue Scheme was developed as a guide for clinicians when deciding which tongue lacerations need suturing.

References

Bolt RW, Watts PG. The relationship between aetiology and distribution of facial lacerations. Inj Extra. 2004;35(1):6–11. doi:.https://doi.org/10.1016/j.injury.2003.11.010
Bringhurst C, Herr RD, Aldous JA. Oral trauma in the emergency department. Am J Emerg Med. 1993;11(5):486–90. doi:.https://doi.org/10.1016/0735-6757(93)90091-O
Lamell CW, Fraone G, Casamassimo PS, Wilson S. Presenting characteristics and treatment outcomes for tongue lacerations in children. Pediatr Dent. 1999;21(1):34–8.
Banks K, Merlino PG. Minor oral injuries in children. Mt Sinai J Med. 1998;65(5-6):333–42.
English GM. Otolaryngology. New York: Harper and Row; 1976. p 463.
Andreasen JO, Andreasen FM. Textbook and color atlas of traumatic injuries to the teeth. St Louis: Mosby-Year; 2007. pp 587–93.
Powers MP, Bertz J, Fonseca RJ. Management of soft tissue injuries. In: Fonseca RJ, Walker RV, editors. Oral and maxillofacial trauma. Philadelphia: WB Saunders; 1991. pp 618–48.
Donat TL, Maisel RH, Mathog RH. Injuries to the mouth, pharynx and esophagus. In: Bluestone CD, Stool SE, Kenna MA, editors. Pediatric otolaryngology 3rd ed. Philadelphia: WB Saunders; 1996. pp 1183–4.
Touloukian RJ. Pediatric trauma. St. Louis: CV Mosby; 1990. p 204.
Ud-din Z, Aslam M, Gull S. Should minor mucosal tongue lacerations be sutured in children? Emerg Med J. 2007;24(2):123–4. doi:.https://doi.org/10.1136/emj.2006.045211
Morrongiello BA, Ondejko L, Littlejohn A. Understanding toddlers’ in-home injuries: I. Context, correlates, and determinants. J Pediatr Psychol. 2004;29(6):415–31. doi:.https://doi.org/10.1093/jpepsy/jsh046
Rudresh KB, Prashanth R, Bhattacharjee B, Vinod B, Nandan RP. Paediatric tongue laceration – a unique repair. Int J Oral Health Med Res. 2016;3(3):50–3.
Flinzberg S, Friedrich RE, Vesper M, Schmelzle R. Komplikation bei der Anwendung des 2-Octyl-Cyanoacrylat-Gewebeklebers (Dermabond) [Injury by the use of 2-octocyanoacrylate tissue adhesive Dermabond]. Trauma und Berufskrankheit. 2001;3(2):156–8. Article in German. doi:.https://doi.org/10.1007/s100390100419
Brown DJ, Jaffe JE, Henson JK. Advanced laceration management. Emerg Med Clin North Am. 2007;25(1):83–99. doi:.https://doi.org/10.1016/j.emc.2006.11.001
Rettenbacher T, Macheiner P, Hollerweger A, Gritzmann N, Weismann C, Todoroff B. Suture granulomas: sonography enables a correct preoperative diagnosis. Ultrasound Med Biol. 2001;27(3):343–50. doi:.https://doi.org/10.1016/S0301-5629(00)00364-1

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Seiler M, Massaro SL, Staubli G, Schiestl C. Tongue lacerations in children: to suture or not?. Swiss Med Wkly [Internet]. 2018 Oct. 28 [cited 2024 Dec. 3];148(4344):w14683. Available from: https://smw.ch/index.php/smw/article/view/2532

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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[1] Bolt RW, Watts PG. The relationship between aetiology and distribution of facial lacerations. Inj Extra. 2004;35(1):6–11. doi:.https://doi.org/10.1016/j.injury.2003.11.010

[2] Bringhurst C, Herr RD, Aldous JA. Oral trauma in the emergency department. Am J Emerg Med. 1993;11(5):486–90. doi:.https://doi.org/10.1016/0735-6757(93)90091-O

[3] Lamell CW, Fraone G, Casamassimo PS, Wilson S. Presenting characteristics and treatment outcomes for tongue lacerations in children. Pediatr Dent. 1999;21(1):34–8.

[4] Banks K, Merlino PG. Minor oral injuries in children. Mt Sinai J Med. 1998;65(5-6):333–42.

[5] English GM. Otolaryngology. New York: Harper and Row; 1976. p 463.

[6] Andreasen JO, Andreasen FM. Textbook and color atlas of traumatic injuries to the teeth. St Louis: Mosby-Year; 2007. pp 587–93.

[7] Powers MP, Bertz J, Fonseca RJ. Management of soft tissue injuries. In: Fonseca RJ, Walker RV, editors. Oral and maxillofacial trauma. Philadelphia: WB Saunders; 1991. pp 618–48.

[8] Donat TL, Maisel RH, Mathog RH. Injuries to the mouth, pharynx and esophagus. In: Bluestone CD, Stool SE, Kenna MA, editors. Pediatric otolaryngology 3rd ed. Philadelphia: WB Saunders; 1996. pp 1183–4.

[9] Touloukian RJ. Pediatric trauma. St. Louis: CV Mosby; 1990. p 204.

[10] Ud-din Z, Aslam M, Gull S. Should minor mucosal tongue lacerations be sutured in children? Emerg Med J. 2007;24(2):123–4. doi:.https://doi.org/10.1136/emj.2006.045211

[11] Morrongiello BA, Ondejko L, Littlejohn A. Understanding toddlers’ in-home injuries: I. Context, correlates, and determinants. J Pediatr Psychol. 2004;29(6):415–31. doi:.https://doi.org/10.1093/jpepsy/jsh046

[12] Rudresh KB, Prashanth R, Bhattacharjee B, Vinod B, Nandan RP. Paediatric tongue laceration – a unique repair. Int J Oral Health Med Res. 2016;3(3):50–3.

[13] Flinzberg S, Friedrich RE, Vesper M, Schmelzle R. Komplikation bei der Anwendung des 2-Octyl-Cyanoacrylat-Gewebeklebers (Dermabond) [Injury by the use of 2-octocyanoacrylate tissue adhesive Dermabond]. Trauma und Berufskrankheit. 2001;3(2):156–8. Article in German. doi:.https://doi.org/10.1007/s100390100419

[14] Brown DJ, Jaffe JE, Henson JK. Advanced laceration management. Emerg Med Clin North Am. 2007;25(1):83–99. doi:.https://doi.org/10.1016/j.emc.2006.11.001

[15] Rettenbacher T, Macheiner P, Hollerweger A, Gritzmann N, Weismann C, Todoroff B. Suture granulomas: sonography enables a correct preoperative diagnosis. Ultrasound Med Biol. 2001;27(3):343–50. doi:.https://doi.org/10.1016/S0301-5629(00)00364-1