What is the management and treatment for an upper lip laceration?

Management of Upper Lip Lacerations

Upper lip lacerations should be repaired using topical anesthetic agents (LET or lidocaine-epinephrine-tetracaine) applied for 20-30 minutes, followed by layered closure with absorbable sutures for facial wounds to avoid the pain of suture removal, or tissue adhesives for low-tension wounds. 1

Initial Assessment and Preparation

Wound Evaluation

• Assess the depth of the laceration to determine if it involves only the vermilion (mucosal surface), crosses the vermilion-cutaneous border, or extends into deeper structures including the orbicularis oris muscle 2
• Examine for involvement of the "white roll" (the ridge at the vermilion-cutaneous border), as accurate restoration of this landmark is critical for aesthetic outcomes 2
• Evaluate wound tension, as this determines closure method 1

Anesthesia Selection

• Apply topical LET (lidocaine, epinephrine, tetracaine) solution directly to the open wound for 20-30 minutes until wound edges appear blanched 1
• Use 3 mL for patients >17 kg or 0.175 mL/kg for patients <17 kg 1
• Cover with an occlusive dressing or place a cotton ball soaked with LET solution into the wound 1
• For urgent situations or supplemental anesthesia, inject buffered lidocaine with bicarbonate slowly using a small-gauge needle to minimize pain 1

Closure Techniques Based on Laceration Location

Vermilion-Only Lacerations

• Use a transverse mucosal incision to hide the scar at the junction of the vermilion and vestibular mucosa 2
• This approach is appropriate when the laceration is located exclusively on the mucosal surface 2

Lacerations Crossing the Vermilion-Cutaneous Border

• Employ a vertical incision or wedge excision for bulkier lesions that cause lip lengthening or cross anatomic boundaries 2
• Precise alignment of the vermilion border is essential to prevent visible step-off deformities 2

Low-Tension Wounds

• Consider tissue adhesives (octyl cyanoacrylate) for essentially painless closure 1
• Alternatively, use Steri-Strips as a less expensive painless option 1

Wounds Requiring Sutures

• Use absorbable sutures for facial wounds to eliminate the pain and anxiety of suture removal 1
• Perform layered closure: the dermis provides the greatest strength and should be accurately approximated to the opposite dermis 3
• Epidermal coaptation provides aesthetic polish but does not contribute to wound strength 3

Post-Repair Care

Immediate Wound Care

• Apply white soft paraffin ointment to the lips every 2-4 hours to protect and moisturize 4
• Clean the mouth daily with warm saline mouthwashes to reduce bacterial load 4

Pain Management

• Prescribe acetaminophen or ibuprofen for routine pain control 1
• Reserve opiates only if needed 1
• Apply ice packs to reduce swelling 1

Oral Hygiene and Diet

• Use a soft toothbrush with mild fluoride-containing toothpaste 2
• Avoid irritants including spicy foods, hot foods and drinks, and citrus fruits 2
• Avoid alcohol-containing mouthwashes, which cause additional pain and irritation 4

Follow-Up

• Arrange early follow-up within two weeks to assess healing 1
• Examine the wound 2-3 days after closure for signs of infection 3

Critical Pitfalls to Avoid

• Do not use petroleum-based products chronically on lips, as they promote mucosal dehydration and create an occlusive environment that increases secondary infection risk 5
• Avoid placing full-thickness sutures through the lip except on palmar and plantar surfaces, as fat and muscle do not support sutures 3
• Do not attempt to suture through orbicularis oris muscle without proper technique, as debulking while preserving vermilion is exceedingly difficult 2
• Ensure scars are placed along natural boundaries (vermilion border, philtral columns) when possible to optimize cosmetic outcomes 2