Assessment and management of lip lacerations
- Judd E Hollander, MD
Judd E Hollander, MD
- Professor and Vice Chair Department of Emergency Medicine
- Thomas Jefferson University
- Lauren N Weinberger Conlon, MD
Lauren N Weinberger Conlon, MD
- Assistant Professor Department of Emergency Medicine
- University of Pennsylvania
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
Lacerations continue to be a leading cause of emergency department visits. Minor wound management should reduce the likelihood of infection and be performed to achieve minimal scarring . It is especially critical that lip lacerations are repaired correctly to preserve the cosmetic appearance and functionality of the lip. When interacting with people, our vision is immediately directed towards the eyes and lips highlighting the aesthetic importance of lip structure. The lip also serves a critical role in speech articulation, food ingestion, and tactile sensation. Most lacerations can be repaired by the emergency clinician; however, there are rare circumstances where specialist referral may be necessary.
When evaluating trauma to the face and lip care should be taken to evaluate the patient for other traumatic injuries and the clinician should follow Advanced Trauma Life Support (ATLS) protocol. The patient should undergo primary assessment of airway, breathing, circulation, disability and neurologic function prior to secondary survey for additional injuries.
The lip is a unique structure in the body and in cross section is composed of three layers: the mucosal layer (within the oral cavity), the middle muscular layer (orbicularis oris muscle), and the outer mucosal layer consisting of the wet vermillion (internal oral) and the dry vermillion (external oral) or the “red lip” (figure 1). The cosmetic outline of the lip where the facial skin meets the vermillion is referred to as the vermillion border. Aesthetically the vermillion border is crucial as light reflects at this juncture and misalignment by 1 mm will cause a noticeable scar.
The blood supply to the lip arises from the superior and inferior labial arteries which are branches of the facial artery (figure 2).
The lip is innervated by the infraorbital and inferior alveolar nerves which arise from the trigeminal nerve (cranial nerve V) (figure 3).
- Singer AJ, Hollander JE, Quinn JV. Evaluation and management of traumatic lacerations. N Engl J Med 1997; 337:1142.
- 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.
- Armstrong BD. Lacerations of the mouth. Emerg Med Clin North Am 2000; 18:471.
- Grunebaum LD, Smith JE, Hoosien GE. Lip and perioral trauma. Facial Plast Surg 2010; 26:433.
- Attia MW, Loiselle J. Management of soft-tissue injuries of the mouth. In: Textbook of Pediatric Emergency Procedures, 2nd edition, King C, Henretig FM (Eds). (Eds), Lippincott, Williams & Wilkins, Philadelphia, PA 2008. p.680.
- GOLDBERG MH. ANTIBIOTICS AND ORAL AND ORAL-CUTANEOUS LACERATIONS. J Oral Surg 1965; 23:117.
- Paterson JA, Cardo VA Jr, Stratigos GT. An examination of antibiotic prophylaxis in oral and maxillofacial surgery. J Oral Surg 1970; 28:753.
- Altieri M, Brasch L, Getson P. Antibiotic prophylaxis in intraoral wounds. Am J Emerg Med 1986; 4:507.
- Steele MT, Sainsbury CR, Robinson WA, et al. Prophylactic penicillin for intraoral wounds. Ann Emerg Med 1989; 18:847.
- Abubaker AO. Use of prophylactic antibiotics in preventing infection of traumatic injuries. Dent Clin North Am 2009; 53:707.
- Mark DG, Granquist EJ. Are prophylactic oral antibiotics indicated for the treatment of intraoral wounds? Ann Emerg Med 2008; 52:368.
- Physical examination
- Ancillary studies
- INDICATIONS FOR SUBSPECIALTY CONSULTATION OR REFERRAL
- WOUND REPAIR
- Indications for primary closure
- Contraindications and precautions
- - Anesthesia and analgesia
- Regional block
- Procedural sedation
- - Irrigation and debridement
- - Equipment
- OTHER CONSIDERATIONS
- Tetanus prophylaxis
- Prophylactic antibiotics
- Bite wounds
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS