Lip laceration

Background

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)

Management

• Antibiotics not required
• 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

• Usually outpatient

See Also

• Laceration repair

References

• Rosens Chapter 42 - Facial Trauma