The patient with a pierced tongue.
Abstract: Patients with a pierced tongue are appearing with increasing frequency in our anaesthetic practice and much has been written in the literature over the past decade. Some patients are reluctant to remove their piercing when requested to do so. The literature suggests that it can take between 4 and 6 weeks to consolidate the tract, and patients often complain that removing piercings before this time leads to rapid healing due to the highly vascular nature of the tongue (Marenzi 2004). A telephone survey of our local body piercing establishments suggested that even an established tract can heal in a matter of a few hours. A new tract can certainly become functionally closed within an hour. We have recently seen two cases in our practice which highlighted interesting learning points.

KEYWORDS Tongue piercing/Body piercing/Airway problems/Anaesthesia
Subject: Body piercing (Health aspects)
Anesthetics (Health aspects)
Preoperative care (Analysis)
Authors: Clapham, Edward
Crooke, James
Pub Date: 05/01/2011
Publication: Name: Journal of Perioperative Practice Publisher: Association for Perioperative Practice Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 Association for Perioperative Practice ISSN: 1750-4589
Issue: Date: May, 2011 Source Volume: 21 Source Issue: 5
Product: Product Code: 2834280 Anesthetic Preparations NAICS Code: 325412 Pharmaceutical Preparation Manufacturing SIC Code: 2834 Pharmaceutical preparations
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 272168017
Full Text: The problem

A patient on our elective list was advised by their piercing practitioner that wearing a plastic replacement for their metal stud was a 'surgery friendly' option. It would both keep the piercing tract open whilst negating the possibility of diathermy burns (Marenzi 2004). We were a little alarmed that this misleading notion may be widespread within the community of piercing practitioners; the non-conductive plastic stud may indeed be 'surgery friendly' but this does not mean that it is 'anaesthesia friendly'.

There have been reports of anaesthetic complications with tongue jewellery relating to the management of the airway and tracheal intubation. Laryngeal spasm, secondary to bleeding from trauma around the piercing, as well as tongue swelling have been reported under general anaesthesia (Wise 1999, Kuczkowski & Benumof 2002). Authors have also commented that plastic studs may be difficult to see if they are translucent, and difficult to retrieve if they become lost as they are radiolucent (Pandit 2000). It is reasonable to suggest therefore that tongue studs should be removed during anaesthesia. However, this presents a conflict of priorities.

A possible solution

A second patient we anaesthetised had encountered this problem before and showed us her own, rather elegant solution, which was both anaesthesia and surgery friendly. The technique was similar to the one described by Brown (2000) using an epidural catheter, but has the advantage that the patency of the tract is never lost. The technique is familiar to anyone who uses Seldinger techniques.

The technique

The ball is unscrewed from the bar of the piercing, and one end of a tube cut from a 19 gauge butterfly needle is pressed firmly onto the threads (Figure 1). The bar is then withdrawn from the tongue, drawing the tube through the tract (Figure 2). The bar is then removed from the tube and re-united with the ball for safe keeping. The ends of the butterfly tube can then be tied to form a safety loop (Figure 3) which ensures easy discovery and removal in the case of an emergency.

The technique gives the advantage of a flexible, soft, nonconductive substitute to a body piercing. It is unlikely to cause trauma and can, in the event of a problem, be easily found, cut and removed.

We feel that these patients highlighted the problems associated with tongue piercings and provided a suitable solution which the anaesthetist can use in everyday practice.

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Acknowledgements

Many thanks to Jo Sutton, Staff Nurse on ward 15B at Southport District General Hospital for her kind assistance in helping to produce the photographs.

No competing interests declared

Provenance and Peer review: Unsolicited contribution; Peer reviewed; Accepted for publication February 2011.

References

Brown DC 2000 Anesthetic considerations of a patient with a tongue piercing, and a safe solution Anesthesiology 93 (1) 307-308

Kuczkowski KM, Benumof JL 2002 Tongue piercing and obstetric anaesthesia: Is there cause for concern? Journal of Clinical Anesthesia 14 (6) 447-448

Marenzi B 2004 Body piercing: A patient safety issue Journal of PeriAnesthesia Nursing 19 (1) 4-10

Pandit JJ 2000 Potential hazards of radiolucent body art in the tongue Anesthesia & Analgesia 91 (6) 1564-1565

Wise H 1999 Hypoxia caused by body piercing Anaesthesia 54 (11) 1129

Correspondence address: Edward Clapham, York Teaching Hospitals NHS Trust, Wigginton Road, York, YO31 8HE. Email: edwardclapham@hotmail.com

About the authors

Edward James Clapham

MBChB

Foundation Doctor, York Teaching Hospitals

NHS Trust

James William Crooke

MBChB, FRCA

Consultant Anaesthetist, Southport and Ormskirk

Hospitals NHS Trust
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