Daily Bolus of LR: Intra-oral lacerations

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March 15, 2011 by dailybolusoflr

Intra-oral lacerations

The first step in caring for patients with intra-oral lacerations is to remember to look for them! The lips must be everted to determine whether or not an intra-oral lip laceration is present. Noting an extra-oral lip laceration should always prompt the provider to determine whether or not the laceration communicates with the oral cavity (a so called through and through laceration).

The most common etiology of intra-oral lip lacerations is compression of the tissue over the teeth when an external blunt force is applied. In instances when there are chipped or missing teeth, don't forget to search in the intra-oral wounds to ensure pieces are not stuck there.
Irrigation should be performed in all intra-oral wounds due to the high risk of contamination and infection.

In general, intra-oral mucosal lacerations should be repaired under the following situations:
1. Large gaping wounds that interfere with chewing
2. Wounds large enough that it seems food particles would get entrapped
3. General rule- wounds larger than 2cm

For repair, an absorbable suture is best used.

Lastly, in through and through lacerations:
1. When the intra-oral component is small, consider only repairing the external wound to limit the likelihood of infection from intra-oral bacteria which will be present in the wound.
2. Most texts recommend prophylactic antibiotics in these wounds. Literature is sparse in support or refute.

Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions

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