Intraoral laceration occur quite often. Whether it’s a sports injury or any other traumatic incident, lacerations inside the mouth are often seen along with other injuries such as bone fractures.
What is a laceration?
A laceration refers to a wound that is produced by the tearing or the distortion of the soft body tissues. These types of wounds are often irregular and uneven. Bacteria and debris often contaminate a laceration wound if they are not treated in a timely manner. The margins of a laceration tend to be uneven and gape open. Generally, motor vehicle accidents, contact sports, animal bites, etc. can lead to such injuries.
The regions of the deformed tissues are prone to inflammation, and can lead to scar formation if they are not sutured together. The depth of the laceration often times determines the course of action as there are many layers of suturing that may be needed.
A vast range of abilities and specialization are required to achieve the proper result of oral laceration repair. A regular process of laceration repair needs the involvement of a primary physician or dentist. A more complex laceration demands attention of a plastic surgeon or an oral and maxillofacial surgeon.
Let us delve deeper into the different oral laceration repair processes.
Lip Laceration Repair
Achieving the optimal result in the case of lip laceration depends heavily on the basic surgical principles of wound repair.
Lip lacerations in most cases are accompanied by dental injuries and facial fractures. Carefully explore the lip laceration to ensure that there are no foreign bodies. If you observe dental interventions, do not neglect it. Appropriate imaging can help to find out whether any other damage has taken place. Consider performing an X-Ray (CT Scan) to identify any embedded tooth fragments.
Conduct a close inspection of the wound to find out any evidence of salivary fluid. Consider testing all the branches of the facial nerve to rule out nerve damage. If you detect a full-thickness laceration without any injury to the any major glands or facial nerves, you can proceed with the repair process.
The process of lip laceration repair
- Begin with proper cleaning and irrigation of the wound. Keep in mind that copious irrigation may, at times, distort the wound margin causing further damage.
- Lip anesthetization can be difficult since it often results in swelling or distortion of the wound margin. For the lower lip, a mental nerve block and for the upper lip, an infraorbital nerve block can be used to anesthetize. Small intraoral lacerations can be left to heal on their own.
- Large intraoral lacerations trap food particles and pose difficulty in chewing. Hence, they need to be repaired with resorbable sutures. Gut sutures are typically used to bring the wound margins together in these cases.
- A series of sutures is placed from deep to superficial to properly close the wound without any dead space. A dead space occurs when the deeper layers of the wound are not properly close creating an air-pocket that could be a nidus for bacteria.
- Since the sutures dissolve on there own, there is no need to return to have them removed.
- Complete healing takes place in around 6 weeks.
- Pain medication and antibiotics will be prescribed after the procedure to prevent any residual infection.
Tongue Laceration Repair
Tongue lacerations are mainly seen in toddlers and children. The typical indications for this include laceration that is bigger than 1 cm, lacerations that lead to the bisection of the tongue, gaping wounds, and uncontrolled bleeding. Most of the tongue lacerations are small in size and therefore can be repaired quickly. It is best to use a short-acting local anesthetic for this.
Patients can be given sedatives (such as Ketamine), local anesthetic, or pain medication, depending on their condition and requirement. A lingual nerve block or an inferior alveolar nerve block may be helpful to anesthetize the anterior two-third portion of the tongue.
The process of tongue laceration repair
- The tongue is numbed with a lingual nerve block or local infiltration around the wound site
- Inspect within the tongue to rule out any foreign bodies
- The ideal suture for tongue lacerations is a 4-0 or a 5-0 chromic gut stitch using simple interrupted suture placement. The ideal suture depth is around half of the depth of the tongue
- Once suturing is completed irrigate with normal saline
- Antibiotics and pain medication will be prescribed
- No follow up is normally needed, and complete healing will take place in 8 weeks
Oral lacerations, if handled properly, can be resolved in a manner where little to no scar tissue is formed. With the proper oral surgery team, you can be on the road to recovery in no time. If you are suffering from a laceration that needs repair, contact our team today.