Lower Lip Laceration Across the Vermilion
SeungJu Jackie Oh MD
, Melissa Mastroianni MD
History:
28-year-old healthy female patient with lower lip laceration after falling from bunk bed 1 hour prior to arrival. -LOC. Low concern for other acute traumatic injuries. Clinically stable and alert & oriented x3.
Findings:
3-cm lower lip laceration across vermilion border. No intraoral lacerations.
No evidence of fracture or loose teeth.
Figure 1: 3-cm lower lip laceration across vermilion border.
Figure 2: 3-cm lower lip laceration across vermilion border.
Diagnosis:
Lower lip laceration across the vermilion border.
Differential Diagnoses:
R/O associated injuries.
Workup Required:
Examination of face and intra-oral structures to R/O fractures and dental injuries.
Plan:
Complex repair of laceration under local anesthesia/ nerve block in the ED.
Expertise Needed:
Plastic surgeon.
Treatment:
Patient was placed in a reclined sitting position. Right mental nerve (aim for 2nd premolar) block achieved with 3cc of 2% lidocaine . Wound was thoroughly irrigated with normal saline mixed with betadine. Then proceeded with layered closure under loupe magnification: 5-0 Monocryl for muscle, 5-0 Chromic simple interrupted sutures for mucosa, and 6-0 Prolene* simple interrupted sutures for skin. Bacitracin was applied to wound. Patient tolerated the procedure well.
Figure 3: Lip laceration s/p layered closure.
Figure 4: Lip laceration s/p layered closure, involving satisfactory approximation of the lower lip vermilion border.
-Discharge Instructions:
- Keep wound clean and dry. Twice daily bacitracin
- Minimize movement of mouth (taking big bites of food, etc) for 3-4 days
- No antibiotics needed
- Follow-up clinic 1 week for suture removal
Follow Up:
Seen in clinic 1 week for suture removal. Well-healing wound as noted in image below. Instructed to continue 1 additional week of twice daily bacitracin. Follow-up PRS clinic as needed.
Figure 3: 1-week s/p repair.
References
Grunebaum, Lisa Danielle, Jesse E. Smith, and Gia E. Hoosien. "Lip and perioral trauma." Facial plastic surgery 26.06 (2010): 433-444.
Brown, Daniel J., Jon E. Jaffe, and Jody K. Henson. "Advanced laceration management." Emergency medicine clinics of North America 25.1 (2007): 83-99.
Walsh, Ryan, et al. "A Cost-Effective Task Trainer for Complex Lip Laceration Repair." Cureus 13.3 (2021).
http://dx.doi.org/10.1055/s-0030-1267717
http://dx.doi.org/10.1016/j.emc.2006.11.001
http://dx.doi.org/10.7759/cureus.13659