By David M. James MD
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Additional info for Field Guide to Urgent and Ambulatory Care Procedures
Refer patient to appropriate consultant. ps 5/14/01 10:01 AM Page 40 CHAPTER 11 Lip Laceration and Vermilion Border Repair Lacerations to the lip are commonplace and may result from any number of sharp or blunt mechanisms of trauma. Because of the excellent vascular supply of the lips, these wounds tend to bleed profusely. The lacerations may be confined to the vermilion portion of the lip itself or may cross the vermilion border of the lip. Lacerations caused by teeth may traverse all tissue layers (mucosa, muscularis, and external skin), resulting in a “through-and-through” type of laceration.
10. Update tetanus immunization as required. Laceration Crossing the Vermilion Border: 11. Obtain history of the injury and perform physical examination as outlined earlier. Obtain a radiograph of the facial soft tissues if warranted due to an unaccounted-for portion of a tooth. PRACTICAL TIP • There is another technique for anesthesia of a lower lip laceration that minimizes any tissue distortion from injected lidocaine. This technique takes advantage of the pathway of the mental nerves, which exit from the mental foramen externally on both sides of the mandible.
Choices include amoxicillin-clavulinic acid 500 to 875 mg po bid; clindamycin 150 to 300 mg po bid; cephalexin 250 to 500 mg po tid PLUS metronidazole 500 mg po bid; or erythromycin 250 to 500 mg po qid, all for a 10-day course. 9. External skin sutures should be removed in 5 days by the primary care physician or the consultant. 10. Update tetanus immunization as required. Laceration Crossing the Vermilion Border: 11. Obtain history of the injury and perform physical examination as outlined earlier.