What is the treatment for trauma-induced swelling over the lips?

Treatment of Trauma-Induced Lip Swelling

Apply white soft paraffin ointment to the lips every 2 hours immediately after injury and continue throughout the acute healing phase to prevent drying and reduce inflammation. 1, 2, 3

Immediate Management (First 24-48 Hours)

Initial Wound Assessment and Cleaning

• Cleanse the face and oral cavity thoroughly with water or sterile normal saline to remove debris and facilitate accurate examination 1
• Examine for associated injuries including facial bone fractures (palpate facial skeleton), dental trauma, intraoral lacerations, and signs of neurologic injury 1
• Rule out concussion by assessing for loss of consciousness, dizziness, headache, or nausea—if suspected, prioritize cervical spine protection and immediate medical evaluation 1

Cold Therapy and Compression

• Apply ice with mild compression (10 mm Hg pressure) for 40-minute periods during the first 15 minutes to several hours post-injury, as this combination produces highly significant reduction in swelling compared to cooling alone 4
• Cold therapy alone provides only transient attenuation of swelling, but when combined with pressure creates sustained anti-edema effects 4

Lip-Specific Protective Care

• Apply white soft paraffin ointment every 2 hours to prevent cracking and maintain moisture barrier 1, 2, 3
• Avoid chronic use of petroleum jelly alone beyond the acute phase, as it promotes mucosal cell dehydration and creates an occlusive environment that increases secondary infection risk 1, 5

Anti-Inflammatory and Pain Management

Systemic Medication

• Acetaminophen (paracetamol) is the preferred first-line agent, as it reduces post-traumatic swelling by approximately 30% and provides effective analgesia 6, 7
• Dose acetaminophen at 60 mg/kg/day divided into four doses for pediatric patients 2
• Avoid acetylsalicylic acid (aspirin), as it fails to reduce and may actually increase post-traumatic swelling 6
• For severe cases requiring more aggressive anti-inflammatory therapy, single-dose or short-term glucocorticoids reduce swelling by approximately 50% and provide superior pain relief compared to NSAIDs 6
• Glucocorticoids are equally effective whether administered immediately or 2-3 hours post-injury 6

Topical Anti-Inflammatory Therapy

• Use benzydamine hydrochloride oral rinse or spray every 2-4 hours, particularly before eating, for localized pain control 1, 3, 5
• For significant inflammation, apply topical corticosteroids (betamethasone sodium phosphate 0.5 mg in 10 mL water as rinse-and-spit, or clobetasol propionate 0.05% mixed with Orabase) four times daily 1, 5

Oral Hygiene and Infection Prevention

Daily Cleaning Protocol

• Clean the mouth daily with warm saline mouthwashes to reduce bacterial colonization 1, 3
• Gently sweep an oral sponge in the labial and buccal sulci to prevent fibrotic scarring 1
• Use only alcohol-free mouthwashes, as alcohol-containing products cause additional pain and irritation 1, 3, 5

Antiseptic Therapy

• Apply antiseptic oral rinse twice daily using either 1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash (10 mL twice daily) 1, 3
• Dilute chlorhexidine by up to 50% if soreness occurs 1

Antibiotic Considerations

• Do not use prophylactic antibiotics for simple traumatic lip injuries 2
• Reserve antibiotics only for established infection evidenced by increasing pain beyond 24-48 hours, purulent discharge, fever, or positive bacterial cultures 2, 3
• When infection is confirmed, administer appropriate antibiotics for at least 14 days 3

Advanced Pain Control (If Needed)

• For inadequate pain control with benzydamine, use viscous lidocaine 2% (15 mL per application) as topical anesthetic 1, 3, 5
• Maximum lidocaine dose without epinephrine for children is 1.5-2.0 mg/kg 2
• For severe oral discomfort, cocaine mouthwashes 2-5% can be used three times daily 1, 5
• Do not prescribe topical anesthetics for intraoral use in young children due to accidental ingestion risk 2

Follow-Up and Warning Signs

Reassessment Timeline

• Monitor for signs of infection including increasing pain, redness, or swelling beyond 24-48 hours, purulent discharge, fever, and wound dehiscence 2
• Reevaluate diagnosis if no improvement occurs after 2 weeks of appropriate treatment 3, 5
• Obtain bacterial and fungal cultures if secondary infection is suspected 1, 5

Long-Term Complications

• Watch for labial and intraoral scarring that may restrict mouth opening or cause difficulty eating/speaking 1
• Up to 40% of patients may develop sicca syndrome from minor salivary gland damage 1

Critical Pitfalls to Avoid

• Never apply adhesive dressings on or near the lips, as they cause additional trauma upon removal 2
• Avoid hot drinks, spicy foods, citrus fruits, and raw/crusty foods during acute healing 1
• Do not use alcohol-containing products (mouthwashes, smoking) that exacerbate tissue injury 1, 3, 5