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)


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

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

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

External Links

References

  • Rosens Chapter 42 - Facial Trauma