Lacerations of the tongue often require special consideration considering the tongue's anatomic location and functional importance. Repair of tongue lacerations are often plagued by patient intolerance and inadequate anesthesia of the area. This posts aims to introduce the basics of management of tongue lacerations. 

Managing Tongue Lacerations:

• Not all tongue lacerations need repair. Non-gaping, linear, <1 cm lacerations to the central portion of the dorsum of the tongue will heal on their own.
• Large/deep tongue lacerations, lacerations that bisect the tongue, or lacerations along the lateral borders of the tongue require repair.
• Repair with absorbable 4-0 Vicryl or chromic gut
• Approximate wound edges loosely to allow for subsequent swelling of tongue
• Tie sutures with a minimum of four knots as movement of tongue can loosen sutures.

Tips:

• Local injection of lidocaine may be sufficient anesthesia for the procedure
• Inferior alveolar nerve blocks will anesthetize the ipsilateral anterior 2/3 of the tongue. Remember to do bilateral nerve blocks if lacerations cross midline.
• Surgical towel clamp with or without 4x4 gauze can be used to extend tongue from oral cavity
• Large caliber 0-silk or 0-nylon and be temporarily passed through anterior portion of tongue and used to extend tongue out of oral cavity

References:
1. Beaudreau, Ronald W.. "Oral and Dental Emergencies." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016