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inspected for any missing, displaced, mobile, tender, or fractured teeth. These
findings are discussed in more detail in subsequent sections.
Radiographic examination. Radiographs are a valuable supplement to the
clinical examination. However, in a child with acute orofacial/dental injuries this
may be difficult and reserved for a dental office. A chest radiograph may be
required if an avulsed tooth is not located. Panoramic radiographs or computed
tomography (CT) scans may be indicated to assess for jaw fracture.

SOFT TISSUE INJURY
CLINICAL PEARLS AND PITFALLS
The soft tissues and bones of the lower and midface are well
vascularized and bleed profusely when injured.
Lacerated soft tissues must be evaluated for any debris, foreign body,
or tooth fragment.

Current Evidence
Hemorrhage is best controlled by direct pressure and when needed, by ligating
any vessels that are easily seen. However, vessels of the face often retract when
severed making them difficult to visualize. If there is extensive blood loss, the
patient should be assessed for signs of shock (see Chapter 10 Shock ). The injured
area should be thoroughly examined for a foreign body such as a tooth fragment.
This may include obtaining a soft tissue radiograph or bedside ultrasound before
suturing when a foreign body is suspected. Infection and poor wound healing are
potential sequelae of such an oversight.

Goals of Treatment
The primary goal for treatment of soft tissue injury is to achieve hemostasis. The
highly vascular tissue in and around the mouth can lead to significant blood loss
with seemingly mild injuries. Recognizing any embedded foreign materials (e.g.,
debris, or tooth fragments) is essential to allow wound healing and reduce the
likelihood of complications. Injuries to the buccal mucosa and inner lip are rarely

of cosmetic concern given rapid wound healing with minimal risk of scarring.
Vermilion border injuries require meticulous alignment for optimal cosmetic
outcome, while select intraoral lesions may not require any repair at all.

Clinical Considerations