Management of Pediatric Lip Lacerations
For pediatric lip lacerations, provide immediate pain control with oral acetaminophen or topical lidocaine, clean the wound with warm saline, and repair lacerations crossing the vermilion border with meticulous attention to anatomic alignment to prevent permanent cosmetic deformity.
Initial Assessment and Pain Control
Assess the laceration for depth, involvement of the vermilion border (the junction between the red lip and skin), and muscle involvement, as these factors determine repair complexity. 1
- Administer oral acetaminophen for systemic pain relief 2
- Apply topical 2.5% lidocaine ointment cautiously to the wound edges, using sparingly to avoid accidental ingestion and systemic toxicity 2
- Consider topical anesthetic preparations containing tetracaine and epinephrine for facial and lip lacerations, which provide complete anesthesia for approximately 95% of repairs 3
- Avoid overuse of topical anesthetics, as accidental ingestion can lead to toxicity in young children 2
Wound Preparation
- Clean the wound with warm saline using gauze or an oral sponge 4, 2
- Remove any debris or foreign material from the laceration 5
- Assess for associated injuries including dental trauma, tongue lacerations, or through-and-through injuries 5, 6
Repair Technique Based on Laceration Location
The vermilion border is the critical landmark—misalignment by even 1mm creates permanent visible deformity. 1, 6
For lacerations crossing the vermilion border:
- Align the vermilion border first with the initial suture to ensure perfect anatomic restoration 1, 6
- Use a vertical incision approach for lesions traversing both vermilion and cutaneous tissues 4, 7
- Place subsequent sutures in layers: oral mucosa, muscle (orbicularis oris), and skin 1, 6
For lacerations confined to the vermilion (red lip):
- Use a transverse mucosal incision to hide the scar at the junction of the vermilion and vestibular mucosa 4, 7
- Repair in layers if muscle is involved 1
For simple mucosal lacerations:
- Small intraoral lacerations (<2cm) without muscle involvement may heal without repair 5
- Larger mucosal lacerations require absorbable sutures 5, 6
Post-Repair Care
Apply white soft paraffin ointment to the lips every 2 hours during the acute healing phase to prevent drying and cracking. 4, 8
- Lubricate lips with lip balm or petroleum-based ointment frequently 8, 7
- Clean the mouth daily with warm saline mouthwashes 4, 2
- Maintain oral hygiene with a soft toothbrush and mild fluoride toothpaste 8, 7
- Avoid irritants including spicy foods, hot foods and drinks, and citrus fruits, as these delay healing 8, 2, 7
Feeding Considerations
- Ensure adequate hydration, as painful lip injuries may cause children to resist drinking 2
- Offer soft, bland foods at room temperature during the healing period 8, 2
- For infants, nursing care is important as adjunct therapy 4
Indications for Specialist Referral
Refer to a plastic surgeon or oral surgeon for: 9, 6
- Lacerations involving >25% of the lip 1
- Complex injuries with significant tissue loss requiring reconstruction 6
- Bulky lesions causing lip lengthening that require wedge excision 4, 7
- Through-and-through lacerations with significant muscle disruption 6
- Injuries where you are uncertain about achieving proper vermilion border alignment 1, 6
Critical Pitfalls to Avoid
- Misalignment of the vermilion border creates permanent visible deformity—this is the most important technical consideration 1, 6
- Excessive topical anesthetic use leading to systemic toxicity 2, 3
- Inadequate layered closure resulting in notching or step-off deformities 1, 6
- Failure to identify through-and-through injuries requiring intraoral repair 5, 6