Management of Traumatic Lip Hematoma
For traumatic hematomas of the lower lip, early drainage is the most effective treatment to prevent skin necrosis and should be performed as soon as possible after injury.
Assessment of Lip Hematoma
Before proceeding with drainage, evaluate:
- Size and extent of the hematoma
- Presence of tension (suggesting risk of skin necrosis)
- Time elapsed since injury
- Patient's coagulation status (anticoagulant use)
- Signs of infection or necrosis
Treatment Algorithm
1. Small Hematomas Without Tension
- Apply cold compresses for the first 24 hours
- Elevate head while sleeping
- Avoid trauma to the area
- Monitor for signs of increasing size or tension
2. Hematomas Under Tension
These require immediate intervention to prevent skin necrosis:
Drainage Technique
- Clean the area with antiseptic solution
- Administer local anesthesia (if needed)
- Use one of two approaches:
- Simple Aspiration Technique: Using an 18G needle and syringe for fresh hematomas (within 24 hours) 1
- Incision and Drainage: For organized hematomas (>24 hours old)
- Make a small incision at the most dependent or fluctuant part of the hematoma
- Evacuate the hematoma completely
- Irrigate the cavity with sterile saline
- Apply gentle pressure to prevent reaccumulation
Post-Drainage Care
- Apply pressure dressing for 24 hours
- Prescribe appropriate analgesics
- Consider antibiotics if contamination is suspected
- Follow-up within 48-72 hours
3. Large or Complex Hematomas
For extensive hematomas or those with signs of necrosis:
- Surgical debridement may be necessary
- Consider performing debridement and coverage in a single stage to reduce complications and hospital stay 2
- For hematomas with necrosis, debridement of necrotic tissue followed by primary closure or secondary healing depending on the extent
Special Considerations
Anticoagulated Patients
- Higher risk of hematoma formation and expansion
- May require more aggressive early intervention
- Consider temporary adjustment of anticoagulation in consultation with the prescribing physician
Infection Risk
- Monitor for signs of infection (increasing pain, redness, warmth, purulent drainage)
- Low threshold for antibiotic therapy if infection is suspected
Follow-up Care
- Regular monitoring until complete resolution
- Warm compresses after 48 hours to help absorption of residual hematoma
- Soft diet to minimize lip movement during healing
- Avoid trauma to the area
Complications to Watch For
- Reaccumulation of hematoma
- Infection
- Skin necrosis
- Scarring or deformity
The evidence strongly suggests that early intervention for tension hematomas provides better outcomes 2, 1. When debridement and coverage are required, performing them in a single stage reduces hospital stay and medical complications 2.