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Assessment and management of intra-oral lacerations

INTRODUCTION

Intra-oral lacerations represent a small percentage of lacerations, but the repair of them has some important differences relative to lacerations of the skin. Once serious airway compromise is excluded, careful assessment of concurrent oral injuries is necessary. Oral lacerations commonly occur from the impact of teeth on oral mucosa secondary to motor vehicle accidents, contact sports, industrial accidents, and personal violence; fortunately, lacerations that do not gape open often heal well without intervention. Larger, gaping oral lacerations benefit from wound closure to reduce infection and bleeding complications. Most lacerations can be repaired by the emergency clinician; however, there are rare circumstances where specialist referral may be necessary.

Minor wound management, methods of suture placement, repair of adjacent anatomic sites, and evaluation of dental or oropharyngeal trauma are discussed in detail separately:

ANATOMY

Intra-oral lacerations often heal faster than wounds elsewhere in the body due to the extensive vascular supply in this area. Dental avulsion and luxation injuries associated with oral lacerations should be addressed immediately and prior to wound closure so that, if needed, reimplantation is performed as soon as possible and access to injured teeth is not compromised. Delay in reimplantation can decrease chances of tooth survival. Dental fractures can be repaired hours after injury, and oral lacerations should be addressed first. (See "Evaluation and management of dental injuries in children" and "Jaw fractures in children", section on 'Clinical evaluation' and "Facial trauma in adults", section on 'Temporomandibular joint'.)

Important anatomic considerations when repairing oral lacerations include:

                      

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Literature review current through: Jul 2014. | This topic last updated: Jun 17, 2013.
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References
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  1. Powers MP, Beck BW, Fonseca RJ. Management of soft tissue injuries. In: Oral and Maxillofacial Trauma, 2, Fonseca RJ, Walker RV, Betts NJ, et al. (Eds), WB Saunders, Philadelphia 1997. Vol 2.
  2. Armstrong BD. Lacerations of the mouth. Emerg Med Clin North Am 2000; 18:471.
  3. Moskop JC. Informed consent in the emergency department. Emerg Med Clin North Am 1999; 17:327.
  4. Code of ethics for emergency physicians. American College of Emergency Physicians. Ann Emerg Med 1997; 30:365.
  5. Tsai AK, Schafermeyer RW, Kalifon D, et al. Evaluation and treatment of minors: reference on consent. Ann Emerg Med 1993; 22:1211.
  6. Mantilla Gómez S, Danser MM, Sipos PM, et al. Tongue coating and salivary bacterial counts in healthy/gingivitis subjects and periodontitis patients. J Clin Periodontol 2001; 28:970.
  7. Grunebaum LD, Smith JE, Hoosien GE. Lip and perioral trauma. Facial Plast Surg 2010; 26:433.
  8. GOLDBERG MH. ANTIBIOTICS AND ORAL AND ORAL-CUTANEOUS LACERATIONS. J Oral Surg 1965; 23:117.
  9. Paterson JA, Cardo VA Jr, Stratigos GT. An examination of antibiotic prophylaxis in oral and maxillofacial surgery. J Oral Surg 1970; 28:753.
  10. Altieri M, Brasch L, Getson P. Antibiotic prophylaxis in intraoral wounds. Am J Emerg Med 1986; 4:507.
  11. Steele MT, Sainsbury CR, Robinson WA, et al. Prophylactic penicillin for intraoral wounds. Ann Emerg Med 1989; 18:847.
  12. Abubaker AO. Use of prophylactic antibiotics in preventing infection of traumatic injuries. Dent Clin North Am 2009; 53:707.
  13. Mark DG, Granquist EJ. Are prophylactic oral antibiotics indicated for the treatment of intraoral wounds? Ann Emerg Med 2008; 52:368.