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Lip lacerations - lacerations of the lip must have the vermilion border approximated exactly.

Lacerations involving the muscle layers or through-and-through lip lacerations require approximation of each layer (muscle to muscle, mucosa to mucosa and skin to skin).

 


Intraoral lacerations - minor mucosal breaks require no suturing, and mouthwashes should be suggested. Larger tears should be repaired with absorbable, preferably mattress sutures.


Through-and-through facial lacerations - intraoral mucosa, muscular layer and skin surface must all be approximated. Failure to repair the muscular layer, which may be retracted, can later result in a depression of the scar.

Facial nerves or parotid duct injuries should not be overlooked. The facial nerve is motor and in five main branches (temple, xygomatic, bucal, mandibular, cervical).

The parotid duct is found on a line between the tragus of the ear and the angle of the mouth. Drooping of the upper lip, for example, would signify division of the buccal nerve branch. This is often accompanied by parotid duct injury.

The middle third of a line from the targus to the middle of the upper lip indicates the general course of the parotid duct.

 



Ear lacerations - conservative debridement should be the rule. Good skin closure over cartilage is needed to avoid chondritis. Take the skin and perichondrium in a single bite using a removable suture material. Use many sutures to contour the tissue to the normal looking anatomy.

Anticipate hematoma formation if there is significant trauma - use a pressure dressing. A cauliflower deformity will be prevented


Eyelid lacerations - it is best to refer to Ophthalmology all eyelid lacerations other than minor surface ones. Beware of associated ocular or nasal lacrimal duct injury. Layer by layer closure (conjunctival, tarsus, skin) must be done.

Lid margin lacerations require repair with eversion to prevent notching.

Eyebrow lacerations are usually easily repaired with simple sutures. Eyebrows should not be shaved.

 


Nailbed injuries - if there is significant subungual hematoma

then suspect a nail bed disruption and/or a distal phalangeal fracture. The nail bed, if lacerated, should be repaired with absorbable sutures to prevent nail deformity in the future. An intact nail can be glued or sutured back in proper position to act as a splint and for protection of the nailbed.



 
©2003 Department of Emergency Medicine, University of Ottawa

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