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Management of soft tissue injuries of the oral cavity follows the same emergency
care principles used for extraoral soft tissue injuries. Injuries to the lip result in
significant swelling after minor trauma. Lacerations of the tongue and frenum
bleed profusely because of the richness of their vascularity. However, ligating
specific vessels is usually unnecessary because bleeding almost always stops with
direct pressure and careful suturing. Frenum lacerations often heal spontaneously
without suturing. When a laceration in the oral cavity is more than 6 hours old,
decisions regarding primary closure need to consider the relative risk of
secondary infection.
Management
Suturing. Suturing the lip must be done carefully to achieve a precise
approximation of the edges of the vermilion border to avoid a disfiguring scar. If
necessary, the lip must be sparingly debrided. Wounds are generally closed with
5-0 or 6-0 sutures. Nylon sutures may be used in cooperative teenagers; however,
fast-absorbing sutures are preferred in younger children given the potential
challenge of subsequent suture removal. Through and through and other deep lip
lacerations require closure in multiple layers, beginning with approximation of
the orbicularis oris muscle using 4-0 chromic and then 5-0 or 6-0 sutures (as
above) for the skin and vermilion border. Most superficial tongue lacerations heal
without suturing. When necessary, tongue lacerations are usually sutured with 4-0
chromic in superficial wounds and with 3-0 chromic in deeper wounds. With
tongue lacerations, it is important to consider the excessive muscular movements
that pull at the sutures; therefore, tongue sutures should be made deep into the
musculature (see Chapter 110 Minor Trauma ).
Orthodontic trauma. Young patients are frequently undergoing orthodontic
treatment, and trauma can result in loosening of wires or ligatures that are
attached to orthodontic brackets or bands. Acutely, the emergency physician can
bend the wire away for analgesic purposes and to avoid further soft tissue injury.
Once this is temporarily addressed, arrangements for urgent dental evaluation can
be pursued. Loose wires can be covered with softened wax or removed to allow
the traumatized soft tissues to heal. If no discomfort is noted and no loose foreign

bodies are present, definitive treatment can be delayed until the patient can be
seen by an orthodontic specialist.
Postanesthesia soft tissue trauma. Young children may injure oral soft tissues
(lips, intraoral mucosa, or tongue) after administration of local anesthesia for a
dental procedure. The child may be numb for several hours postprocedure. This
provides an opportunity for injury, which will appear as a whitish ulceration and