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Three Part Question

In [children with mucosal tongue lacerations] is [conservative management as good as suturing] at [producing an acceptable outcome]

Clinical Scenario

A 3yr old boy presents to A&E dept after falling from a swing in the playground at school. He sustains a 1cm non-gaping laceration to dorsal third of tongue. The parents are very anxious about stitches. You wonder whether any intervention is required.

Search Strategy

Medline 1966-11/2006 using the OVID interface.
Cochrane Library Issue 4 2006
Medline:[(lacerat$.mp. OR cut.mp. OR wound.mp. OR trauma.mp. OR injur$.mp. OR tear$.mp) AND (exp tongue OR langue.mp. OR lingual.mp. OR gloss$.mp.) AND maximally sensitive RCT filter LIMIT to human AND English.
Cochrane:tongue [MeSH descriptor explode all trees] 76 records 0 relevant

Search Outcome

Altogether 575 papers were found of which only one had any relevance. The relevant paper is shown in the table below.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Lamell CW et al, 1999, USA	28 patients aged 1-9 with tongue lacerations of which 22 evaluated for result- managed by predetermined selection criteria- 1.Gaping wound at rest 2.Lateral border wounds 3.Active haemorrhage	Observational Study	Difference in quality of result with suturing or not	No significant difference	25% of pts had no follow-up Lack of calibration of clinicians Small sample size
			Post-trauma morbidity	No significant difference

Comment(s)

No evidence exists to indicate which lacerations should be sutured and which should be managed conservatively. However, there is a general consensus that the main indications for immediate management are uncontrollable haemorrhage, airway compromise and the presence of a significant segment of severed tongue or of a segment at the verge of being severed. It is accepted that minor lacerations of the tongue will heal readily with no impairment of tongue function. There are no PRCTs that address this three part question suggesting that further research is necessary.

Clinical Bottom Line

Local advice should be followed.

References

1. Lamell CW, Fraone G, Casamassimo PS, Wilson S. Presenting Characteristics and Treatment Outcomes for Tongue Lacerations in Children. Paediatric Dentistry 1999;21(1):34-8.