What is the treatment for lip lacerations?

Treatment of Lip Lacerations

For lip lacerations, immediately apply topical anesthetic (LET solution: lidocaine, epinephrine, tetracaine) at triage for 20-30 minutes, then perform layered closure with precise vermilion border alignment using sutures for high-tension wounds or tissue adhesive for low-tension wounds without vermilion involvement. 1

Immediate Wound Management and Anesthesia

• Clean the wound thoroughly with copious sterile normal saline or water to remove all debris and reduce infection risk, ensuring the wound base is completely dry before closure. 2

• Place LET solution directly on the open wound using a cotton ball soaked with the solution, cover with an occlusive dressing, and wait 20-30 minutes until wound edges blanch (indicating adequate anesthesia). 1

  • Dosing: 3 mL for patients >17 kg; 0.175 mL/kg for patients <17 kg 1
  • Contraindications: allergy to amide anesthetics and grossly contaminated wounds 1

• If additional anesthesia is needed after topical application, inject lidocaine using pain-minimizing techniques: buffer with bicarbonate, warm the solution, use a small-gauge needle (25-27 gauge), and inject slowly. 1

  • Maximum lidocaine dose without epinephrine: 1.5-2.0 mg/kg 2

Closure Technique Selection

The critical decision point is whether the vermilion border is involved and the degree of wound tension. 1, 3

For Wounds Involving the Vermilion Border (High-Tension or Complex):

• Perform layered closure with sutures, proceeding from deep to superficial structures: muscle layer, oral mucosa, and skin. 4, 3
• The vermilion border MUST be aligned precisely—this is the key to proper lip laceration repair and determines cosmetic outcome. 3, 5
• Use 4-0 absorbable suture for muscle and oral mucosa layers 4
• Use 6-0 non-absorbable suture for skin layer 4
• Consider absorbable sutures for facial wounds to eliminate the pain and anxiety of suture removal 1

For Low-Tension Wounds WITHOUT Vermilion Border Involvement:

• Octyl cyanoacrylate tissue adhesive provides essentially painless closure—use the least amount necessary to seal the wound. 2, 1
• Steri-Strips offer similar painless closure and are less expensive than tissue adhesives for appropriate wounds 1

For Small Mucosal-Side Lacerations Only:

• Gentle cleaning with warm saline is sufficient—these often heal without closure 2

Antibiotic Management

Do NOT routinely prescribe prophylactic antibiotics for simple traumatic lip lacerations. 2

• Antibiotics should only be considered if there are signs of established infection (increasing pain, purulent discharge, fever). 2
• For large wounds requiring suturing, there may be some benefit to prophylaxis, though evidence is limited. 6

Post-Repair Care

• Apply white soft paraffin ointment or petroleum jelly to the lips every 2 hours during the acute healing phase to prevent drying and cracking. 2, 1

• Instruct patients to clean the mouth daily with warm saline mouthwashes (NOT alcohol-containing mouthwashes, which cause additional pain and irritation). 1, 7

• Apply benzydamine hydrochloride anti-inflammatory rinse or spray every 2-4 hours, particularly before eating. 1

• Instruct patients to avoid irritating foods and drinks during healing 1

Pain Management

• Acetaminophen at 60 mg/kg/day divided into four doses provides adequate pain control while remaining well below toxic thresholds. 2

• Reassess pain regularly and adjust as needed 2

Follow-Up and Warning Signs

Instruct caregivers to watch for signs of infection, including: 2

• Increasing pain, redness, or swelling beyond the first 24-48 hours
• Purulent discharge
• Fever
• Wound dehiscence
• Difficulty eating or drinking due to worsening pain 2

Critical Pitfalls to Avoid

• Never use alcohol-containing mouthwashes post-repair—they cause additional pain and irritation. 1, 7

• Do not use adhesive dressings on or near the lips, as they cause additional trauma when removed. 2

• Do not prescribe topical anesthetics for intraoral use in young children due to risk of accidental ingestion. 2

• Misalignment of the vermilion border leads to permanent aesthetic sequelae with visible fibrosis lines—this must be avoided during initial repair. 4

• Postoperative care by both patient and surgeon is as important as the procedure itself for preventing dehiscence. 4