Lip laceration

Background

Vermilion border (superior lip). Lower border not shown.

In cross section, is composed of three layers:

• Mucosal layer (within the oral cavity)
• Middle muscular layer (orbicularis oris)
• Outer mucosal layer
  • Wet vermillion (internal oral)
  • Dry vermillion (external oral)

The vermillion border is the cosmetic outline of the lip where the facial skin meets the vermillion. Light reflects at this junction, so small misalignments may cause noticeable defects.

Differential Diagnosis

Maxillofacial Trauma

• Ears
  • Auricular hematoma
• Nose
  • Nasal fracture
  • Nasal septal hematoma
• Oral
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

Management

Lip laceration crossing the vermilion border (right). Key suture is at or near the vermilion border to ensure a contiguous line upon healing (left).

• Antibiotics not routinely given, but may be indicated for through and though lip lacerations
• Consider updating tetanus
• Vermillion border and philtrum architecture must be maintained for cosmesis
• Infiltration of local anesthetic can distort soft tissue
  • Consider Nerve Block: Infraorbital for upper lip, Nerve Block: Mental for lower lip
  • Consider marking vermillion border prior to infiltration of anesthetic to facilitate repair

Intraoral mucosal laceration (isolated)

• Only need to close if >1cm
• Use absorbable 5-0 suture
• Avoid catching underlying muscle during suturing

Through-and-through laceration

Close in layers:

1. Close mucosal layer with absorbable 5-0 suture
2. Irrigate from outside
3. Close orbicularis oris muscle with 4-0 or 5-0 absorbable suture
4. Close skin with 6-0 nonabsorbable suture

Vermilion border laceration

• Place 1st stitch with 6-0 nonabsorbable suture to align edges of vermilion border
• Then repair rest of lip in usual manner

Disposition

• Re-evaluation of wound in 48-72 hours
• Removal of non-absorbable sutures in 3-5 days

See Also

• Laceration repair

Special Lacerations by Body Part

• Head
  • Conjunctival laceration
  • Ear laceration
  • Eyelid laceration
  • Lip laceration
  • Scalp laceration
  • Tongue laceration
• Hand
  • Fingertip amputation
  • Nailbed laceration
• Other
  • Bites
  • General laceration repair (main)

References

• Rosens Chapter 42 - Facial Trauma