Tongue Injuries

Wounds to your horse’s tongue can easily go unnoticed— but that doesn’t mean they can be ignored.
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Wounds to your horse’s tongue can easily go unnoticed— but that doesn’t mean they can be ignored.

Injuries to your horse’s tongue are probably not the highest on your list of concerns. Unless your horse is one of those who habitually hangs out his tongue, you may not even see much more than the occasional glimpses of pink as you bridle him. As long as he’s eating normally, and you have no troubles with him accepting your bit, why think about it?

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And yet tongue wounds are more common than most people realize. Harsh bits are a major source of damage, but a horse may also lacerate his tongue on sharp objects or bite it accidentally. And much of the time, you may never even notice the damage. “The majority of tongue issues that I’ve seen had already healed,” says Bruce Connally, DVM, an equine sportsmedicine specialist in Longmont, Colorado. “They are discovered when we’re looking into the mouth for some other reason.”

Even severe tongue injuries may go undetected. “I discovered one old injury---where the tongue had been nearly cut in two and healed---when I was doing a dental exam,” says Connally. “No one suspected this situation; the horse seemed perfectly normal.” Horses can cope well even if a large portion of the tongue is lost. 

Still, the pain of some tongue wounds may affect a horse’s ability to eat, and the scarring, tissue loss, neural damage and other potential aftereffects of these injuries can have long-lasting repercussions, making a horse head shy and/or influencing how he responds to the bit. 

So it’s good to be aware of the many ways a horse can injure his tongue. Accidents happen, but you can take steps to reduce the risk. And, if you can spot trouble quickly, you’ll be ready to seek help sooner should it be necessary. Here’s what you need to know.

Speaking of tongues

The tongue is made up of more than a dozen individual muscles, including both extrinsic muscles, which anchor the organ to the jawbone and hyoid 
apparatus (bones that also support the larynx and pharynx), and intrinsic muscles, which begin and end entirely within the body of the structure. In fact, the tongue is one of the few places in the body where an animal has voluntary control of muscles that aren’t attached directly to bones. 

As in every other animal, the horse’s tongue is highly specialized for the job it does. It is at once a sensory organ---with nerves to detect pain, heat, pressure and taste---and a working tool that enables the horse to eat. The highly mobile forward section works together with the teeth and lips to select and pick up feed or to choose which blades of grass to nip off. Horses are expert nibblers, quite adept at picking up only the choicest bits while leaving the undesirables behind---as anyone can attest who has ever found a medication or supplement left neatly behind after a horse has cleaned up the rest of his feed.

The back of the tongue, where it is anchored to the jaw between the cheek teeth, is integral to chewing and swallowing. Papillae---specialized protuberances on the surface of the tongue---help to guide food into position. The tongue presses the food up against the roof of the mouth where, aided by the ridges there, it is squeezed over onto the chewing surfaces, ground and passed across the tongue again in a spiral that gradually moves it toward the rear of the oral cavity. 

“The part of the tongue that we see is fairly flat, but there is a big lump at the back of the tongue that is used as an aid in swallowing,” says Connally. “There is a very thick muscle back there, and if you look into the mouth and see it you might think there is something wrong with the tongue. That bulge of muscle is normal. The horse’s tongue is very useful---with the big, long mouth area---to help push the food all the way back for swallowing.”

Another important function of the horse’s tongue is to keep the teeth clean. Just as you do, a horse will shift his tongue around in his mouth to dislodge bits of food from his teeth. Then, saliva flushes the surfaces clean.

How seriously a tongue wound affects a horse’s quality of life depends in part on its location. Most injuries occur in the forward, mobile portion of the tongue. Horses generally adapt well, even if a section is severed, because they can compensate and rely more on their lips and teeth to pick up feed. “A horse that has lost very much of the tongue (or it has to be removed after injury) will eat differently, but he generally does OK,” says Connally. “If a cow loses her tongue, she starves to death, because she uses it to pull food into her mouth.”

In contrast, an injury---such as a puncture wound, abscess or ulcer---that occurs in the rear of the mouth can cause enough pain to interfere with chewing. “A severe injury clear at the back could interfere with swallowing,” Connally says. These are the wounds that can cause a horse to lose weight if he cannot eat enough.

How tongues get hurt

• Bit injuries. Bits are perhaps the most common source of tongue wounds in horses. Any sudden forceful pressure or severe jerk---for example, if a horse steps on his reins and pulls back---can lacerate the tongue. Some bits are harsher than others and more apt to cause injury if the reins are jerked, whether accidentally or through rough handling.

“I looked at a horse recently who had a bit scar across 25 percent of the tongue, and the man admitted to me that the horse bucked when he was young and ‘we got a little rough on his mouth.’ But he didn’t know he’d cut the horse’s tongue,” says Connally. The horse had shown no obvious signs of the injury.

Sometimes, a horse may have an old injury and the owner may only be able to surmise what happened. “I bought a horse a long time ago at an auction sale---a very nice Quarter Horse mare with papers,” says Tia Nelson, DVM, a veterinarian/farrier from Helena, Montana. “She was an off-the-track Quarter Horse, and all she knew how to do was run. If it couldn’t be done at a dead gallop, she wasn’t going to do it. I was trying to figure out why she was so hard mouthed, and when I looked into her mouth I found that she had a full-thickness laceration of the tongue that had healed. I think this might have happened if someone used a double-twisted wire snaffle on her, cutting the tongue with the bit. It was interesting to find that much damage to her tongue.”

If you’re unsure of how well your bit fits your horse, ask your veterinarian or a trainer you trust to assess it. You want to use the gentlest bit possible to reduce the risk of injuring your horse.

• Tongue ties. These devices, which clamp the tongue inside the horse’s mouth, are often used in racehorses. “Race trainers use tongue ties and various methods to try to keep the tongue in the mouth when horses run,” says Connally. “No one knows why some horses like to stick out their tongues as they run, but then some people stick their tongue out when threading a needle. Maybe the horse is concentrating.”

A protruding tongue is also undesirable in many show horses, and although these devices are forbidden in most competitions---with a few exceptions, including saddle seat---some trainers use them while bringing along a young horse. However, misuse of tongue ties can easily cut the tongue or cause neural injury. It’s not uncommon for off-the-track Thoroughbreds to loll their tongues---often due to nerve damage that results in partial paralysis. A tight tie can easily cut into or completely sever the tongue.

• Damaged teeth. Fractures, hooks and other problems in the teeth can create sharp edges that damage the tongue. “I’ve seen some huge ulcers and holes in tongues caused by sharp, misplaced teeth,” says Connally. “I had a horse brought to me because he was constantly salivating---drooling buckets of fluid when you put a bit in his mouth. If you took the bit out he was fine. I sedated the horse and took a look into his mouth. He’d gotten kicked some time earlier, which pushed one of his lower cheek teeth so that it was leaning inward, and it was poking under his tongue. He had a hole about two inches in diameter in the bottom of his tongue.”

When the bit was holding the tongue down, the horse couldn’t lift it away from the sharp edge. “We ground that tooth down and he no longer had the irritation and drooling,” says Connally. 

Dental examinations performed at least once a year---or more frequently in older horses or those who’ve had problems in the past---can identify and correct problems like these before the damage is too severe.

• Foreign material in the mouth. 
If a horse picks up a sharp object, such as a piece of wire, with his hay 
or feed, it may cut or become embedded in his tongue. Also, some wild grasses, such as foxtails, produce sharp, spiky seedheads called awns that can cause tongue sores and ulcers. “We often see foxtail abscesses in tongues, and sometimes stickers and sticks jammed into the tongue. I’ve pulled several pieces of wire out of tongues,” Connally says. “Last year I examined a horse who was salivating and eat-ing funny, and when I got my hand far enough back in the mouth I was able to find and pull out a two-and-a-half-inch piece of wire that was stuck into the side of the tongue---almost as far back as the last cheek tooth. When we got the wire out, the horse did fine.” 

Younger horses, especially foals, are more likely to be “mouthy,” nibbling and chewing on things they shouldn’t eat. If a foal injures his tongue, he won’t be able to nurse. “The tongue is crucial for nursing,” says Connally. “If he can’t suck, you might have to train him to drink from a bucket so he can dunk his mouth far enough into the liquid to create suction. I’ve seen newborn calves and foals with swollen tongues after a hard birth, and they can’t nurse until the swelling goes down. They may need to be fed with a nasogastric tube until they can nurse.”

Checking hay for foreign objects and clearing away debris on the farm, especially around feeders, is always a good idea. Be aware, though, that one common source of metal embedded in horses’ tongues may be the feeder itself---many people use old tractor tires as hay feeders, but if the steel belting is exposed, the horses can easily pick up bits of metal. If you use tractor tires as feeders, consider either switching to a different type or at least replacing them when the rubber wears off of the belting.

• Biting. Accidental biting is rare, but occasionally, a horse may catch 
his tongue between his teeth with enough force to slice right through it. In one case, an owner was holding a mare’s tongue out of the side of her mouth while a veterinarian was attempting to examine her teeth. This is a common practice to help immobilize a horse’s head while keeping the mouth open. But in this case, the mare jerked back and clamped her teeth, and the tongue came off in the owner’s hand. An attempt to reattach the tongue failed, but the severed edge healed well, and the mare was able to graze and eat normally. 

“The important thing when doing a mouth examination and holding the tongue out the side of the mouth is to hold onto the tongue and the halter together,” says Connally. “Even if the horse doesn’t bite his tongue, if he tries to pull away, there is danger of pulling on the tongue hard enough to paralyze it. If the horse jumps backward and you continue hanging onto the tongue to hold him, you may pull so hard on the tongue that it won’t work properly anymore. When doing any mouth exam, make sure you have one finger hooked in the halter so that either you go with the horse if he pulls back, or you are quick enough to release your hold---to turn him loose and let him go. But every now and then someone continues to hang on as that horse is pulling back, and it’s not a good thing!”

Holding the tongue to the side may be a good option for brief looks inside a horse’s mouth. But if a more thorough examination is needed, or any floating or other work needs to be done, a speculum is a far safer option for holding a horse’s mouth open.

In an even more unusual scenario, one horse might bite off the tongue of another. Nelson once cared for a stallion whose tongue was nearly severed. Apparently, he had been squabbling with another stallion through the fence, and the other horse grabbed his tongue. “It was a bizarre injury, lacerating the tongue very deeply---all the way through,” Nelson says. 

Looking for trouble

Bleeding is the most immediate sign of a recent tongue injury, but you may not see a lot of blood, if any. “Some of these injuries must not bleed very much, because I rarely find an owner who knows the tongue has been cut,” says Connally. “Some horses may simply swallow the blood, and it doesn’t come out of the mouth.”

Even profuse bleeding may not be evident. “I was called to work on one horse who had licked the sharp edge of some metal siding and cut the tongue about two-thirds of the way off, and I had to remove the rest,” says Connally. “By the time I was called to see it, the tongue was black and hanging out of the horse’s mouth. The owner had not noticed the injury earlier, and it was too late to try to save the tongue. That owner never saw it bleeding. There was nothing noticeable until the tongue was black and protruding.”

Other signs of injury may include excessive drooling, dropping hay or feed, or foul-smelling breath. If a horse is experiencing pain within his mouth, he may also stand with his head outstretched or his behavior may just seem subtly “off.” He may also resist accepting the bit or even just having his head 
approached and handled. 

The treatment options depend on the cause and severity of the injury. Obviously, any embedded foreign objects will be removed and dental issues addressed. A freshly lacerated tongue may require sutures but not necessarily. Many may be left to heal without treatment. “I’ve only seen a couple of tongue injuries that had to be dealt with; most heal on their own,” says Connally.

If surgical closure is needed, a veterinarian is likely to opt for absorbable stitches, which dissolve over time and so do not need to be removed. “We have some really good absorbable suture materials now that will last a month of more before they dissolve,” says Connally. “This is much easier than trying to take them out later. Also you can’t bury nylon suture knots or they would act as a foreign body irritation.”

In the case of the stallion with the tongue bitten through by another horse, Nelson was initially dubious about trying sutures. “In all the reading that I’d done, the literature said that tongue lacerations don’t heal very well and that the horses often end up losing that part of the tongue,” she says. But she decided to take the risk: “We had nothing to lose, and it might work,” Nelson says. “I thought we could give it a chance and see what happens.”

The gamble paid off: “His tongue healed perfectly, even though it was cut full thickness, more than halfway across the tongue,” Nelson says. “He literally never looked back; he never had any problems and continued eating, drinking and behaving normally.” Today, you’d never guess that he’d ever had an injury.

Since then, Nelson has sutured a number of tongue injuries, with generally good results. “Tongue lacerations can be varied and interesting, and I’ve enjoyed putting them back together,” she says. “We’ve done several, and they all healed nicely. To work on this kind of injury we just sedate the horse and insert a full-mouth speculum, and then I have a helper hold the tongue out for me. The ones that I’ve done have responded nicely to suturing. So I don’t hesitate to suture tongues now.” 

If the wound is not discovered promptly, debridement may be neces-sary to remove dead tissue at the site. “If the wound is older, I try to get down to fresh tissue, which has a better chance to grow back together properly,” Nelson says.

When a sutured tongue doesn’t heal well, a section may need to be removed. But the loss of even a large portion of the more mobile area of the tongue usually isn’t catastrophic. “These horses generally adjust---even with a lot of the tongue missing---and do fine,” says Nelson. You would never suspect that they’d lost it, if you didn’t look.

While a tongue wound is healing, you may want to wet down your horse’s hay and feed to make it easier to manage in his mouth, or switch to hay cubes or a softer forage, but many do just fine without special treatment. It’s also a good idea to avoid riding with a bit until the injury heals.

Keep in mind that even healed injuries may affect how a horse responds to a bit, especially if the injury was in or close to the bit path. Although many horses with healed tongues may behave normally, in some, bits can continue to irritate or cause pain in scarred and/or deformed tissue. If a horse with an old tongue injury doesn’t respond well or is aggravated by his bit, you may need to try a different type or even switch to some form of a bitless bridle. As for eating, though, most horses do just fine, even with a lot of scar tissue that limits mobility.

Horses can get themselves into all kinds of trouble and injure themselves in surprising ways. “I am continually impressed with all the things horses can do to hurt themselves,” says Nelson. And while a tongue injury may not be the most catastrophic wound a horse can sustain, it’s still a good idea to be aware of what can happen so you can be ready to deal with it should it ever happen to your horse.