What is the treatment for a cheek laceration caused by biting the inside of the cheek?

Treatment of Cheek Laceration from Biting the Inside of the Cheek

For a cheek laceration caused by biting the inside of the cheek, thorough wound cleansing with sterile normal saline followed by careful monitoring for signs of infection is the recommended approach, with prophylactic antibiotics indicated due to the high risk of infection from oral flora. 1

Initial Management

Wound Assessment and Cleaning

• Examine the wound to determine depth and extent of injury
• Clean the wound thoroughly with sterile normal saline (no need for iodine or antibiotic-containing solutions) 1
• Remove any superficial debris
• Avoid deep debridement as it may unnecessarily enlarge the wound 1

Wound Irrigation

• Perform gentle irrigation to remove foreign bodies and pathogens 1
• Avoid irrigation under pressure as this can spread bacteria into deeper tissue layers 1

Antimicrobial Management

Prophylactic Antibiotics

• Human bite wounds, including self-bites to the cheek, should receive prophylactic antimicrobials regardless of wound appearance 1
• This is due to the polymicrobial nature of human oral flora, which includes:
  • Streptococci (present in 80% of wounds)
  • Staphylococci
  • Haemophilus species
  • Eikenella corrodens
  • Anaerobes (present in 60% of cases) including Fusobacterium, peptostreptococci, Prevotella, and Porphyromonas species 1

Recommended Antibiotic Regimens

• First-line: Amoxicillin-clavulanate (provides coverage against the common oral pathogens) 1
• Alternatives for penicillin-allergic patients:
  • Doxycycline
  • Fluoroquinolones plus metronidazole or clindamycin (for anaerobic coverage)

Caution

• Avoid first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone as they have poor activity against some oral pathogens 1

Wound Closure Considerations

For Facial Wounds

• Facial wounds are an exception to the general rule about delayed closure of bite wounds
• These can be closed primarily if there has been:
  • Meticulous wound care
  • Copious irrigation
  • Administration of prophylactic antibiotics 1
• Ideally, evaluation by a specialist with experience in facial wounds is recommended 1

Timing of Closure

• Early closure (<8 hours after injury) may be appropriate for facial wounds
• For wounds presenting later or showing signs of infection, consider:
  • Approximation of margins with Steri-Strips
  • Delayed primary closure or healing by secondary intention 1

Follow-Up Care

Monitoring

• Follow up within 24 hours either by phone or office visit 1
• Monitor for signs of infection:
  • Increasing pain
  • Redness
  • Swelling
  • Purulent discharge
  • Fever

Complications to Watch For

• Infectious complications may include:
  • Local infection
  • Abscess formation
  • Rarely, bacteremia 1
• Non-infectious complications may include:
  • Scarring
  • Nerve or tissue damage
  • Functional impairment if severe

Special Considerations

Tetanus Prophylaxis

• Ensure tetanus prophylaxis is current
• If outdated or unknown status, administer tetanus toxoid (0.5 mL intramuscularly) 1

Pitfalls to Avoid

1. Underestimating the infection risk of human bite wounds
2. Failing to provide appropriate antibiotic prophylaxis
3. Aggressive debridement that may enlarge the wound unnecessarily
4. Delayed treatment, which increases infection risk
5. Inadequate follow-up to monitor for complications

By following these guidelines, the risk of infection and complications from a cheek laceration caused by biting the inside of the cheek can be minimized, leading to better healing and outcomes.