eMedicine Specialties > Clinical Procedures > Soft Tissue Procedures

Complex Laceration, Lip

Author: Gretchen S Lent, MD, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center
Coauthor(s): Linda G Liu, MD, Attending Physician, Department of Emergency Medicine, Rochester General Hospital
Contributor Information and Disclosures

Updated: Jul 27, 2009

Introduction

Laceration of the lip is an injury commonly seen in emergency departments. Careful repair is necessary to ensure the best cosmetic results.1,2 For more information, see Facial Soft Tissue Injuries and Facial Soft Tissue Trauma.

The lip is composed of the orbicularis oris muscle covered externally by the skin and internally by oral mucosa. The commissure is the lateral border of the oral cavity where the upper and lower lips join. The vermilion is the white roll that forms the free border of the lip at the cutaneous junction. This area is the focus of repair because even 1 mm of vermilion misalignment may be noticeable.3,4 For a detailed discussion of lip anatomy, see Lips and Perioral Region Anatomy.

Illustration of the upper and lower vermilion bor...

Illustration of the upper and lower vermilion border.

[ CLOSE WINDOW ]
Illustration of the upper and lower vermilion bor...

Illustration of the upper and lower vermilion border.



Lip laceration involving the lower vermilion bord...

Lip laceration involving the lower vermilion border.

[ CLOSE WINDOW ]
Lip laceration involving the lower vermilion bord...

Lip laceration involving the lower vermilion border.



Lip laceration involving the upper vermilion bord...

Lip laceration involving the upper vermilion border.

[ CLOSE WINDOW ]
Lip laceration involving the upper vermilion bord...

Lip laceration involving the upper vermilion border.

Indications

Unlike the cosmetically important facial lacerations that are almost always closed primarily, certain small intraoral lacerations may be left open without repair.

Indications for intraoral closure 

  • Mucosal laceration that creates a flap that interferes with chewing
  • Mucosal laceration that is large enough to trap food particles
  • Wounds longer than 2 cm

Identification of intraoral skin laceration.

Identification of intraoral skin laceration.

[ CLOSE WINDOW ]
Identification of intraoral skin laceration.

Identification of intraoral skin laceration.


Deep intraoral lip laceration that needs&nbs...

Deep intraoral lip laceration that needs repair.

[ CLOSE WINDOW ]
Deep intraoral lip laceration that needs&nbs...

Deep intraoral lip laceration that needs repair.


Contraindications

  • Certain wounds are best closed in consultation with a plastic surgeon. For more information, see Lip Reconstruction.
    • Large flaps
    • Large amounts of the vermilion border missing
    • Macerated wounds
    • Involvement of the commissure
    • Loss of more than 25% of the lip5
  • Small intraoral lacerations heal well without sutures. Small puncture lacerations through the lip may not require complete closure. The external portion may be repaired while the intraoral portion is allowed to heal without sutures.

More on Complex Laceration, Lip

Overview: Complex Laceration, Lip
Treatment & Medication: Complex Laceration, Lip
Multimedia: Complex Laceration, Lip
References
Further Reading
[ CLOSE WINDOW ]

References

  1. McCarn KE, Park SS. Lip reconstruction. Facial Plast Surg Clin North Am. May 2005;13(2):301-14, vii. [Medline].

  2. Nabili V, Knott PD. Advanced lip reconstruction: functional and aesthetic considerations. Facial Plast Surg. Jan 2008;24(1):92-104. [Medline].

  3. Galyon SW, Frodel JL. Lip and perioral defects. Otolaryngol Clin North Am. Jun 2001;34(3):647-66. [Medline].

  4. Brown DJ, Jaffe JE, Henson JK. Advanced laceration management. Emerg Med Clin North Am. Feb 2007;25(1):83-99. [Medline].

  5. Calhoun KH. Reconstruction of small- and medium-sized defects of the lower lip. Am J Otolaryngol. Jan-Feb 1992;13(1):16-22. [Medline].

  6. Zide BM, Swift R. How to block and tackle the face. Plast Reconstr Surg. Mar 1998;101(3):840-51. [Medline].

  7. Horton CE, Adamson JE, Mladick RA, Carraway JH. Vicryl synthetic absorbable sutures. Am Surg. Dec 1974;40(12):729-31. [Medline].

  8. Heintz WD. Dealing with dental injuries. Postgrad Med. Jan 1977;61(1):261-2, 264, 266. [Medline].

  9. Rao D, Hegde S. Spontaneous eruption of an occult incisor fragment from the lip after eight months: report of a case. J Clin Pediatr Dent. Spring 2006;30(3):195-7. [Medline].

  10. Pektas ZO, Kircelli BH, Uslu H. Displacement of tooth fragments to the lower lip: a report of a case presenting an immediate diagnostic approach. Dent Traumatol. Dec 2007;23(6):376-9. [Medline].

  11. Baurmash HD, Monto M. Delayed healing human bite wounds of the orofacial area managed with immediate primary closure: treatment rationale. J Oral Maxillofac Surg. Sep 2005;63(9):1391-7. [Medline].

  12. Parlin LS. Repair of lip lacerations. Pediatr Rev. Mar 1997;18(3):101-2. [Medline].

  13. Bailey BJ, Nichols ML. Small defects (vermilion mucosa and less than one-third lower lips). In: Calhoun KH, Sternberg CM, eds. Surgery of the Lip. New York, NY: Thieme; 1992.

  14. Calhoun KH. Lip anatomy and function. In: Calhoun KH, Sternberg CM, eds. Surgery of the Lip. New York, NY: Thieme; 1992:1-11.

  15. Daver BM, Antia NH, Furnas DW. Lip and Cheek. In: Handbook of Plastic Surgery for the General Surgeon. 2nd ed. New York, NY: Oxford; 2000:123-128 Chap 7.

  16. Greer SE, Benhaim P, Lorenz HP, et al. Lip Reconstruction. In: Handbook of Plastic Surgery. New York, NY: Marcel Dekker; 2004:195-201 Chap 38.

  17. Marks MW, Marks C. Reconstructive Procedures of the Face. In: Fundamentals of Plastic Surgery. Philadelphia, Pa: WB Saunders; 1997:240-242 Chap 13.

  18. Marx JA, Hockberger RS, Walls RM. Rosen's Emergency medicine: concepts and clinical practice. St Louis, Mo: Mosby; 2002.

  19. Reichman E, Simon RR. Management of Specific Soft Tissue Injuries. In: Emergency Medicine Procedures. New York, NY: McGraw-Hill; 2004:748-762 Chap 80.

  20. Roberts J, Hedges J. Clinical Procedures in Emergency Medicine. 4th ed. Portland, OR: WB Saunders; 2004.

  21. Samo DG. A technique for parallel lacerations. Ann Emerg Med. Mar 1988;17(3):297-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

Clinical guideline on management of acute dental trauma
American Academy of Pediatric Dentistry - Professional Association. 1991 (revised 2007 May). 14 pages. NGC:006230

[ CLOSE WINDOW ]

Keywords

laceration, lip, suture technique, vermilion border, lip wound, lip laceration, complex lip laceration, chipped teeth, tooth fragment, laceration repair, lip wound repair, lip laceration repair, cosmetic lip repair, facial laceration, intraoral laceration, laceration closure, intraoral closure, mucosal laceration, maceration, lip commissure, puncture laceration, facial injury, lower lip nerve block, upper lip nerve block, lip wound irrigation, through-and-through lip wound, facial skin, intraoral skin

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Gretchen S Lent, MD, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center
Disclosure: Nothing to disclose.

Coauthor(s)

Linda G Liu, MD, Attending Physician, Department of Emergency Medicine, Rochester General Hospital
Linda G Liu, MD is a member of the following medical societies: Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Andrew K Chang, MD, Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center
Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Luis M Lovato, MD, Associate Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.