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should also be repaired. Assess patients with tongue lacerations requiring repair
for potential airway problems, as well as the need for sedation or even general
anesthesia. Often, local or regional anesthesia is sufficient. The mouth should be
retained open using a padded tongue depressor placed on the side between the
upper and lower teeth or by using a Denhardt–Dingman side mouth gag. The
tongue can be maintained in the protruded position by a gentle pull using a towel
clip or by placing a temporary suture through the tip to be used for traction.
Interrupted 4-0 absorbable suture, with full-thickness bites to include the two
mucosal surfaces and the lingual muscle between, will close the tongue wound
and provide hemostasis. Multiple knots and inverted sutures are recommended to
prevent the untying of the sutures. Some authors suggest that only deep muscle
closure is required because the mucosal surface heals rapidly. As in lip
lacerations, children may chew off the stitches. Parents must be warned of this
possibility and should attempt to distract the child at least until the local
anesthesia wears off.

Buccal Mucosa Lacerations
Small, isolated lacerations of the buccal mucosa, mostly from impaction of teeth
following falls, require no suturing. Lacerations 2 to 3 cm in length or with flaps
are best closed with simple interrupted absorbable material. Coated Vicryl (4-0)
on a round needle is preferred because it is less irritating to the child and is easier
to work with than chromic gut. Closure of the mucosal surface in through-andthrough lip lacerations should be carried out before closure of the muscle and skin
layers. After repair, a soft diet and avoidance of irritating foods should be
advised, as well as vigilant mouth hygiene. Evaluation for associated injuries of
the teeth or alveolar margin is imperative. Families should be alerted that buccal
mucosa lacerations often develop a white ridge during the healing process which
is normal and does not indicate infection.

FINGERTIP
CLINICAL PEARLS AND PITFALLS