Falls, contact injuries, and child abuse are common causes of injury to the mouth. In children, tongue lacerations may occur through any of these mechanisms, but are most common after a fall or a collision with an object or person in the home [1,2].
The decision whether or not to repair a tongue laceration is controversial. The literature offers vague and conflicting recommendations [1,3,4]. On the one hand, because of the rich vascular supply, most tongue lacerations heal rapidly without intervention. On the other hand, the tongue plays a crucial role in speech and swallowing, and poor outcomes may compromise these functions. Tongue lacerations in which poor healing may compromise tongue function require more aggressive treatment.
As in all trauma patients, the initial clinical assessment should provide rapid identification of potentially fatal conditions. Evaluation for airway compromise, impaired respiratory mechanics, hemorrhagic shock, and altered level of consciousness should be made on arrival at the emergency department. Such systematic evaluation helps ensure detection of potentially serious injuries. The approach to the injured child is discussed in detail separately (figure 1). (See "Trauma management: Approach to the unstable child", section on 'Primary survey'.)
Large lacerations may lead to hemorrhage that can potentially threaten the airway and/or cause hypovolemia. The airway should be evaluated and secured if compromised. Cervical spine immobilization must be maintained in patients in whom cervical spine injury has not been excluded. (See "Basic airway management in children" and "Pediatric cervical spine immobilization" and "Evaluation of cervical spine injuries in children and adolescents" and "Hypovolemic shock in children: Initial evaluation and management", section on 'Fluid resuscitation'.)
History — Determination of the mechanism of injury is crucial in the evaluation of children with tongue lacerations and potentially serious occult injury (eg, cervical spine injury). This is particularly important in children with high-impact trauma (eg, motor vehicle accidents, falls from height, direct blows to the face). Because the tongue is highly vascularized, bleeding caused by laceration may distract attention from the more serious injury.