Treatment and Disposition

Isolated intraoral mucosal lacerations may not need to be sutured. Through-and-through lacerations that do not include the vermilion border can be closed in layers. The mucosal layer is closed with a 5-0 rapidly absorbable suture (e.g., plain gut, Vicryl rapide). Gentle re-irrigation from the outside is recommended to prevent wound infection from intraoral organisms. Next, the orbicularis oris muscle is approximated with 5-0 absorbable suture material (e.g., Vicryl, Dexon, Monocryl) with a simple interrupted or horizontal mattress technique. Finally, the skin is sutured with 6-0 nonabsorbable monofilament material in a simple interrupted fashion. The sutures should be removed in 5 days. Alternatively, the skin can be approximated with tissue adhesive. The use of tissue adhesive on mucosal surfaces is contraindicated.

Wounds that cross the vermilion border should be repaired by placing the first stitch to approximate the edges of the vermilion border precisely ( Fig, 38-6). Even 1

mm of step-off will be cosmetically unpleasing. Following this first stitch, the repair can proceed as previously described. In some cases, it is helpful to place this crucial suture and leave it untied until the remainder of the skin is sutured. Gentle traction on the ends can help approximate underlying tissue to provide optimal cosmesis. Care should be taken to avoid pulling the suture through the skin in this cosmetically delicate area.

FIG. 38-6. Irregular-edged vertical laceration of the upper lip. A. Traction is applied to the lips and closure of the wound is begun first at the vermilion-skin junction. B. The orbicularis oris muscle is then repaired with interrupted, absorbable 4-0 synthetic sutures. C. The irregular edges of the skin are then approximated.

If an underlying fracture of the maxilla or mandible is suspected, radiographic evaluation is required. Patients with open fractures should receive prophylactic antibiotics that provide coverage against oral flora, and a maxillofacial specialist should be consulted.

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