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Gonsalves CL, Zhu JW, Kim GY, Leveille CF, Kam AJ. Surgical versus conservative management of tongue lacerations in the acute care setting: A systematic review of the literature. Paediatr Child Health 2022; 27:32-42. [DOI: 10.1093/pch/pxab044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/14/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
The objective of this study was to determine whether suturing or conservative management of tongue lacerations results in differences in wound healing and functional outcome. The secondary aim was to identify whether antibiotics are required in the treatment of tongue lacerations.
Methods
Studies published between December 1954 and August 2020 were extracted from MEDLINE via PubMed, Embase via OVID, CINAHL via EBSCO, Web of Science, and the Cochrane Library and evaluated for inclusion based on predetermined inclusion and exclusion criteria by two independent reviewers in accordance with PRISMA guidelines.
Results
The search yielded a total of 16,111 articles, 124 of which were evaluated by full-text review, resulting in 11 articles included in this systematic review representing 142 unique cases of tongue lacerations. At least 26 lacerations (18.3%) included penetration of the muscle layer of the tongue, and 24 (16.9%) were classified as full-thickness lacerations. Thirty-five of the 142 tongue lacerations (24.6%) were sutured. The remaining lacerations underwent some form of conservative management. The majority of studies reported excellent healing of tongue lacerations regardless of the management method, with minimal scarring and excellent return to normal functional status. No cases of infection were reported.
Conclusions
Current literature is inconsistent with regards to indications and guidelines for primary repair of tongue lacerations. The majority of tongue lacerations reported in the literature heal with excellent outcomes regardless of management method. Physician judgement along with patient and parental preference based on potential risks of the procedure should be used when deciding whether a tongue laceration requires primary repair. Tongue lacerations in otherwise healthy individuals are at very low risk of infection.
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Affiliation(s)
- Clarelle L Gonsalves
- Michael G. DeGroote School of Medicine, Master University, Hamilton, Ontario, Canada
| | - Jie Wei Zhu
- Michael G. DeGroote School of Medicine, Master University, Hamilton, Ontario, Canada
| | - Grace Y Kim
- Division of Plastic, Reconstructive, and Aesthetic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Cameron F Leveille
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - April J Kam
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Avashia Y, Bittar P, Suresh V, Powers DB. A Novel Approach for the Management and Prevention of Self-Induced Masticatory Lingual Trauma in the Neurologically Injured Patient. Craniomaxillofac Trauma Reconstr 2018; 11:242-248. [PMID: 30087756 DOI: 10.1055/s-0037-1606300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/30/2017] [Indexed: 10/18/2022] Open
Abstract
Self-induced masticatory trauma is an unfortunate complication of a variety of neurologic disorders, including epileptic seizures, cerebral palsy, mental retardation, psychiatric disease, and brain trauma, in addition to other described etiologies. While single or occasional occurrences of tongue biting are relatively benign, recurrent self-injury can pose major issues and predispose a patient to chronic, severe complications. To prevent the complications associated with ongoing trauma to the tongue, steps must be taken to protect individuals from chronic self-injurious behavior. Often, these interventions cause significant morbidity to the patient, such as elective removal of the dentition or complications in gaining access to the oral cavity/airway associated with maxillomandibular fixation. In the neurologically impaired patient, immobilization of the jaws is frequently associated with higher rates of agitation, aspiration, or development of complicating infections of the gingival tissues. We report a case of self-induced masticatory trauma managed with the fabrication of a custom-fabricated oral appliance. This treatment modality successfully prevents the recurrence or incidence of self-induced masticatory trauma to the tongue. The benefits of this modality are that it allows access to the oral cavity, prevents immobilization of the jaws, has minimal to no morbidity, and is completely reversible.
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Affiliation(s)
- Yash Avashia
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Peter Bittar
- Duke University School of Medicine, Durham, North Carolina
| | - Visakha Suresh
- Duke University School of Medicine, Durham, North Carolina
| | - David B Powers
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Brissaud O, Thébaud NB, Guichoux J, Smirani R, Villega F, Devillard R. Case Report of a Severe Recurrent Tongue Self-Injury in an Infant With Dystonia. Pediatrics 2016; 138:peds.2016-0738. [PMID: 27940768 DOI: 10.1542/peds.2016-0738] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 11/24/2022] Open
Abstract
Dystonia is characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive movements, postures, or both that are typically patterned, twisting, and sometimes tremulous. It is often initiated or worsened by voluntary action and associated with overflow muscle activation. In this article we report a case of severe oromandibular dystonia, which is a specific form of dystonia characterized by involuntary, action-induced tonic or clonic spasms of the masticatory, lingual, and pharyngeal musculature. Episodes of repeated tongue biting in a 17-month-old girl caused her to stay in the PICU for 4 weeks. These episodes were the consequence of dystonia induced by a perinatal stroke. We highlight the specific dental management that enabled us to treat the child without extractions. Facing this type of complex illness, we insist on the importance of interdisciplinary work with the goal of avoiding outdated techniques. The use of botulinum toxin seemed relevant.
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Affiliation(s)
- Oliver Brissaud
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Noëlie-Brunehilde Thébaud
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Université de Bordeaux, Bordeaux, France; and.,Institut National de la Santé et de la Recherche Médicale, Bioingénierie Tissulaire, Bordeaux, France
| | - Julie Guichoux
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Rawen Smirani
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Université de Bordeaux, Bordeaux, France; and
| | | | - Raphaël Devillard
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; .,Université de Bordeaux, Bordeaux, France; and.,Institut National de la Santé et de la Recherche Médicale, Bioingénierie Tissulaire, Bordeaux, France
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Suchak A, Mars M. A unique presentation of severe tongue biting in 10 month-old twins with a novel approach to management. Eur Arch Paediatr Dent 2012; 11:149-50. [DOI: 10.1007/bf03262732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Self-inflicted oral injuries of organic origin are particularly common in certain diseases, syndromes, and systemic disorders. In this article, we discuss the characteristics of these oral lesions and their treatment. LITERATURE SEARCH The authors have reviewed the most relevant literature relating to oral self-injury through a search in textbooks and published articles included in the Medline database for the years 1970-2010, and selected published cases from the last two decades. RESULTS The majority of the literature on oral self-injury is in the form of case reports. Self-injury is particularly prevalent in patients with Lesch-Nyhan syndrome, a heterogeneous group of neurological disorders, congenital insensitivity to pain with anhidrosis, and mental retardation. It is most common in males in the early years of life, and the sites most frequently involved are the lower lip and the tongue. Therapeutic approaches in these patients have included psychological and pharmacological treatment, intraoral devices, and surgical procedures. CLINICAL IMPLICATIONS Intraoral devices are the best therapeutic option for self-injury of organic origin, although this approach is not free of complications. The current lack of standardized treatment protocols for oral self-injury means that therapy must be individualized.
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Affiliation(s)
- Jacobo Limeres
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University, Spain Department of Stomatology, School of Medicine and Dentistry, Santiago de Compostela University, Spain
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Kanuga S, Sheller B, Williams BJ, Mancl L. A one-year survey of inpatient dental consultations at a children's hospital. SPECIAL CARE IN DENTISTRY 2012; 32:26-31. [DOI: 10.1111/j.1754-4505.2011.00227.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Romer M, Dougherty NJ. Oral self-injurious behaviors in patients with developmental disabilities. Dent Clin North Am 2009; 53:339-xi. [PMID: 19269402 DOI: 10.1016/j.cden.2008.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Self-injurious behaviors (SIB) in patients who have developmental disabilities is a complex disorder, and its underlying etiologies are poorly understood. SIB is a significant factor in hospitalizations, decisions to use psychotropic medications, and institutional placement for people who have developmental disabilities. Because this group often manifests oral SIB, the dentist may be the first professional called upon to evaluate a patient. Dental therapy focuses on symptomatic treatment to minimize tissue damage caused by SIB, but addressing the underlying impetus for the behavior is essential for successful treatment. Determining definitive therapeutic interventions is difficult because of the mixed bio behavioral etiologies for SIB. This complication necessitates a team approach that includes medical and behavioral specialists.
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Affiliation(s)
- Maureen Romer
- Arizona School of Dentistry and Oral Health, A.T. Still University, 5855 E. Still Circle, Mesa, AZ 85206, USA.
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Affiliation(s)
- V Siapka
- Child Dental Health, Dental School, Bristol, UK.
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Lobbezoo F, Van Der Zaag J, Naeije M. Bruxism: its multiple causes and its effects on dental implants - an updated review*. J Oral Rehabil 2006; 33:293-300. [PMID: 16629884 DOI: 10.1111/j.1365-2842.2006.01609.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is a growing interest in bruxism, as evidenced by the rapidly increasing number of papers about this subject during the past 5 years. The aim of the present review was to provide an update of two previous reviews from our department (one about the aetiology of bruxism and the other about the possible role of this movement disorder in the failure of dental implants) and to describe the details of the literature search strategies used, thus enabling the readers to judge the completeness of the review. Most studies that were published about the etiology during the past 5 years corroborate the previously drawn conclusions. Similarly, the update of the review about the possible causal relationship between bruxism and implant failure reveals no new points of view. Thus, there is no reason to assume otherwise than that bruxism is mainly regulated centrally, not peripherally, and that there is still insufficient evidence to support or refute a causal relationship between bruxism and implant failure. This illustrates that there is a vast need for well-designed studies to study both the aetiology of bruxism and its purported relationship with implant failure.
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Affiliation(s)
- F Lobbezoo
- Department of Oral Function, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
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