CHAPTER 76 Management of Tongue Injuries
The horse’s tongue is a highly mobile, muscular organ that is covered with a tough, specialized squamous epithelium modified to form papillae. By virtue of its relative degree of exposure to the environment, the rostral spatulated portion of the tongue is susceptible to injury. Traumatic injury can arise from bits or other tack placed in the oral cavity, from sharp external objects, blows to the head, injury during recovery from general anesthesia, and iatrogenic damage during intraoral procedures such as dental extraction or transoral epiglottic entrapment release. Injury from a penetrating foreign body, typically wire, is not uncommon, and neurogenic injury is possible.
Minor superficial lacerations of the tongue heal effectively by second intention, usually within 2 weeks. Many of these injuries go unnoticed by owners, and diagnosis of a previous tongue injury may be made incidentally during a routine oral cavity examination. Management of fresh lacerations may include flushing of the oral cavity after meals with an antiseptic solution, warm saltwater, or clean water and short-term administration of a nonsteroidal anti-inflammatory drug (NSAID) for analgesia as indicated. The horse should be observed for comfortable prehension and mastication.
Deep lacerations of the tongue are not uncommon and can be severe, with transverse lacerations seen more frequently than longitudinal lacerations. The free portion of the tongue is usually involved; this part of the tongue has more exposure to the external environment and is in direct contact with the bridle bit. Clinical signs of this type of injury include oral cavity hemorrhage, ptyalism, inappetence, dysphagia, malodorous breath, pyrexia, and tongue protrusion from the mouth. Management of tongue lacerations is guided by the severity, duration, and location of the injury. Primary wound closure, secondary wound healing, or partial glossectomy are approaches to treatment. Surgical procedures are most easily performed on the anesthetized horse; however, the tongue can be operated on in a standing horse with effective sedation and infiltration of local anesthetic. Traction on the tongue for exposure can be achieved by placing towel clamps in the tongue at a site caudal to the laceration or by using a gauze snare at this site, which then also functions as a tourniquet.
Primary closure of severe tongue lacerations is encouraged when possible. The wound edges are debrided of necrotic and contaminated tissue and lavaged vigorously. A multilayer closure to eliminate dead space is recommended. To relieve tension on the closure, vertical mattress sutures are preplaced deep in the muscular body of the tongue with absorbable or nonabsorbable, size 0 or 1, monofilament suture. Buried rows of simple interrupted monofilament absorbable sutures of size 2-0 to 0 are placed to appose the muscles and obliterate dead space. The vertical mattress sutures are tied, and the lingual mucosa is apposed with simple continuous or interrupted vertical mattress sutures of size 2-0 or 0 absorbable suture (Figure 76-1).
Figure 76-1 Closure of a lingual laceration. After vigorous lavage of the wound (A) and debridement of devitalized tissues (B), the laceration is closed with multiple layers of interrupted sutures (C, D). The large vertical mattress tension-relieving sutures are placed first, deep in the tongue musculature.
(From Auer JA, Stick JA, editors: Equine surgery, ed 3, Philadelphia, 2006, Saunders, p 339.)