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Clinical Summary

Lip lacerations may result in significant cosmetic defects if not properly repaired. The lip has two significant anatomic landmarks: the mucosal border (divides intraoral and external portions) and the vermilion border (separates the lip mucosa from facial skin). Meticulous alignment of the vermilion border and its associated “white line” is the cornerstone of cosmetic repair. Lip anatomy may be distorted by the kinetic energy of the impact as well as the resultant edema surrounding the wound. Lacerations of the lip’s vermilion border may be partial or full thickness, compromising the underlying orbicularis oris.

Management and Disposition

Given the high bacterial content of the oral cavity, lip lacerations will not remain clean during repair. The goal of irrigation is to remove clotted blood and gross contaminants such as tooth fragments or dirt. If a fractured tooth is noted, the wound must be explored for fragments. If the tooth or fragment is unaccounted for, then a Panorex or soft-tissue radiograph of the face and a chest radiograph should be obtained. Anesthesia for laceration repair is best performed using either an infraorbital (upper lip) or mental (lower lip) nerve block since local infiltration often distorts the tissue and impairs proper alignment of the vermilion border.

If the vermilion border is violated by a superficial laceration, then the 1st suture, typically 6-0 in size, is placed at the border to reestablish anatomic relationships. Once alignment is judged adequate, simple interrupted sutures are used for completion. If the laceration extends within the oral cavity, absorbable 5-0 sutures are used to close the intraoral component.

With deep or “through and through” lacerations involving the orbicularis oris, the muscle layers are initially approximated with deep, usually 5-0, absorbable sutures. Once the muscle is approximated, the 1st skin suture is again placed at the vermilion border.

Sutures are removed in 3 to 5 days in children and 4 to 5 days in adults. The patient is advised to eat soft foods, not to apply excessive force to the suture line, and to rinse after eating to prevent the accumulation of food particles.

FIGURE 18.19

Vermilion Border Laceration. A complex and a simple vermillion border laceration. (Photo contributor: David Effron, MD.)

Pearls

  1. Misalignment of the vermilion border by as little as 1 mm may result in a cosmetically noticeable defect.

  2. A marking pen may be used to identify landmarks prior to placing the sutures, as suturing itself causes some tissue edema, bleeding, and distortion.

  3. Any patient with a lip laceration requires a thorough inspection of the oral cavity for associated trauma, including dental fractures, oral lacerations, and mandibular injuries.

FIGURE 18.20

Angle Grinder Injury. Facial laceration through the vermillion boarder from a shattered angle grinder disk. (Photo contributor: Lawrence B. ...

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