The common phrase “swallowing your tongue” is a widespread misconception. It is not possible for a person to literally swallow their tongue. The tongue is a muscular organ firmly anchored within the mouth by connective tissues, including the lingual frenulum, which secures it to the floor of the mouth. This anatomical attachment prevents the tongue from detaching.
The Reality of Tongue Obstruction
The tongue can obstruct the airway. When a person loses consciousness, the muscles throughout the body relax, and this includes the muscles of the tongue and those supporting the soft palate. If an unconscious individual is lying on their back, the relaxed tongue can fall backward. Gravity pulls the base of the tongue against the posterior pharyngeal wall, which is the back of the throat.
This posterior movement of the tongue and other soft tissues, such as the epiglottis, can partially or completely block the upper airway. Airflow to the lungs is then restricted or cut off, leading to difficulty breathing or a complete cessation of breathing. When these muscles lose tone, the airway can collapse. This phenomenon is what people commonly refer to as “swallowing the tongue.”
Situations Leading to Airway Obstruction
Airway obstruction caused by the tongue falling backward commonly occurs when there is a significant loss of muscle tone. This can result from various medical conditions or circumstances. Unconsciousness due to injury, fainting spells, or drug overdose can lead to this relaxation.
Seizures also frequently cause a loss of muscle control, which can result in the tongue relaxing and potentially obstructing the airway. Deep sedation or general anesthesia induces muscle relaxation, increasing the risk of the tongue blocking the airway. Individuals with obstructive sleep apnea experience a similar issue during sleep, where relaxed oral muscles cause airway blockage. Lying on the back exacerbates this risk.
Emergency Response for an Obstructed Airway
Prompt action is essential to open the airway and ensure breathing. If there is no suspicion of a spinal injury, the head-tilt/chin-lift maneuver is the recommended first-aid technique. Place one hand on the person’s forehead and gently tilt their head backward. With the other hand, place your fingertips under the bony part of the chin and gently lift it upwards. This action extends the neck, moving the tongue away from the back of the throat and creating a clear passage.
If a spinal injury is suspected, the jaw-thrust maneuver should be used instead to avoid moving the neck. Kneel at the person’s head, place your fingers under the angles of their jaw, and gently lift the jaw upward and forward. This maneuver pulls the tongue forward without tilting the head, maintaining cervical spine stability.
After successfully opening the airway, it is important to check for signs of breathing. Call emergency services and maintain the open airway until medical assistance arrives. If the person is unconscious but breathing, placing them in the recovery position can also help, allowing fluids to drain and preventing the tongue from falling back.