Lower Lip Laceration Across the Vermilion

SeungJu Jackie Oh MD
, Melissa Mastroianni MD


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.


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.


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.


Complex repair of laceration under local anesthesia/ nerve block in the ED.

Expertise Needed:

Plastic surgeon.


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.

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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).

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