Lip laceration: Difference between revisions
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==Background== | ==Background== | ||
In cross section, is composed of three layers | [[File:MouthCupidBow.jpg|thumb|Vermilion border (superior lip). Lower border not shown.]] | ||
In cross section, is composed of three layers: | |||
* Mucosal layer (within the oral cavity) | * Mucosal layer (within the oral cavity) | ||
* Middle muscular layer (orbicularis oris) | * Middle muscular layer (orbicularis oris) | ||
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** Wet vermillion (internal oral) | ** Wet vermillion (internal oral) | ||
** Dry vermillion (external 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. | 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. | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Maxillofacial trauma DDX}} | |||
==Evaluation== | ==Evaluation== | ||
==Management== | ==Management== | ||
*Antibiotics not | [[File:Commissurebeforeandafter2.jpg|thumb|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 | *Vermillion border and philtrum architecture must be maintained for cosmesis | ||
*Infiltration of local anesthetic can distort soft tissue | *Infiltration of local anesthetic can distort soft tissue | ||
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==Disposition== | ==Disposition== | ||
* | *Re-evaluation of wound in 48-72 hours | ||
*Removal of non-absorbable sutures in 3-5 days | |||
==See Also== | ==See Also== |
Revision as of 20:04, 4 February 2021
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)
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.
Clinical Features
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
Management
- 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:
- Close mucosal layer with absorbable 5-0 suture
- Irrigate from outside
- Close orbicularis oris muscle with 4-0 or 5-0 absorbable suture
- 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
External Links
References
- Rosens Chapter 42 - Facial Trauma