Some of the most frequent injuries that present to hospital emergency departments are lip lacerations. Doctors must be very careful when repairing lip lacerations because we depend on our lips and the muscle structure around the lips for our expressions. We communicate nonverbally though many of our facial expressions; therefore, repair of lip lacerations can be very complicated, and may need the expertise of a plastic surgeon.
The anatomy of the lips is so intricate, that repair of the lips is a very exacting process. We great the world with our lips, and when we see body parts on someone that is not quite symmetrical we notice right away. If the eyes aren’t quite the right distance apart, we notice. If the nose is a bit off kilter, we notice; if a corner of one lip is tilted a bit downward while the other corner tips a bit upward, we notice that too. We may not be artists, be we instinctively notice features that lack symmetry.
Lip lacerations that are on the inside of the lip, called intraoral, do not normally affect the symmetry of the lips; therefore, if the wound isn’t too deep it can be left open. A doctor may choose to suture intraoral lip lacerations when the wounds are larger than 2 cm. A wound larger than this is likely to trap particles of food and possibly cause an infection. Normally, small lip lacerations heal fairly quickly.
Depending on how the injury happened, the person may need to have facial X-rays taken to check for fractures. Serious lacerations may only be the superficial problem, there could be serious facial fractures and misalignments. Tetanus shots are good for 10 years; however, with a bad injury the doctor may want to re-vaccinate to protect the person from a possible tetanus infection.
Outer upper or lower lip lacerations that are not serious may not need to be treated at all, because they will heal nicely preserving the natural shape of the lip. The more serious lacerations may be a bit tricky to close. For cosmetic reasons, when the wound edges are approximated, symmetry may or may not be restored with suturing. Suturing of lip lacerations is not always the best choice. Sometimes the best choice is to use a special kind of glue, called dermabond, or even steri-strips.
Lip lacerations that are so severe that connective tissue, blood vessels and nerve tissue has been severed, need to be surgically dealt with in the operating room under general anesthesia. In surgery the area will be thoroughly irrigated with saline solution, and cleansed with a Hibiclens or Betadine solution, or some other kind of disinfecting solution. Jagged wound edges may have to be trimmed with surgical scissors to fit the edges back together again. The surgeon may use sutures, staples, dermabond or some combination of those to repair the lip. The patient may have to wear a surgical dressing on the lip for protection against contamination for a few days until healing begins.