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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 to 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
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