Lip and Perioral Trauma

Abstract

The management of perioral injuries is a complex topic that must take into consideration the unique anatomy, histology, and function of the lips to best restore form and function of the mouth after injury. Basic reconstructive principles include three-layered closure for full-thickness lip lacerations. Additionally, special care is needed to ensure an aesthetic repair of the cosmetically complex and important vermillion border, philtrum, and Cupid's bow. Infraorbital and mental nerve blocks provide lip anesthesia for laceration repair without distorting crucial aesthetic landmarks. Prophylactic antibiotics are usually indicated in perioral injuries due to wound contamination with saliva. Perioral burn management is controversial; however, most lip burns can first be managed conservatively. Splinting, plasties, and other reconstructive options are available after secondary healing of perioral burns. Hypertrophic scars are common in the perioral area after trauma. The mainstays of treatment for hypertrophic scars on the lips are silicone elastomer sheeting and intralesional steroid injections. For large perioral defects, a myriad of reconstructive options are available, ranging from primary closure, cross-lip flaps, and local tissue transfer, to free tissue transfers such as radial forearm free flaps, innervated gracilis free flaps, anterolateral thigh free flaps, and osteocutaneous free flaps.

Lip and Perioral Trauma: Principles of Aesthetic and Functional Reconstruction

“…3 The vermillion border, which defines the junction between the vermillion and nonvermillion cutaneous lips, is an aesthetically important demarcation. 4 Apices of the upper vermillion border along with its central depression are known as Cupid's bow. In this area, the skin and vermillion are separated by a pale rim of tissue called the white roll.…”

“…Perioral musculature is categorized as oral sphincter, as well as upper and lower lip modifiers that fine-tune volitional movements of the lips for expression and other functions. 4 The deep horizontal fibers of the orbicularis oris make up the majority of the oral sphincter, whereas superficial fibers encircle the mouth and facilitate fine movements. Most lip elevators and depressors insert into dermis or submucosa of the lip (►Fig.…”

“…5,11 Primary closure is generally the first-line approach for the treatment of defects without tissue loss where patients present within 24 hours of onset. 4 In contrast, delayed closure may be preferred for contaminated wounds or bites. 1,4,6,10 Extensive debridement should be avoided, with removal limited to clearly devitalized tissue.…”

“…4 In contrast, delayed closure may be preferred for contaminated wounds or bites. 1,4,6,10 Extensive debridement should be avoided, with removal limited to clearly devitalized tissue. 12 Following animal bites, wound edges may be macerated and difficult to align.…”

The Fusion of Craniofacial Reconstruction and Microsurgery

“…72 When microvascular reconstruction is indicated, the preferred options include the radial forearm, ulnar forearm, and innervated gracilis flaps. [73][74][75] The ulnar forearm and radial forearm flaps provide excellent coverage without resultant microstomia as seen in local tissue rearrangements. 76 Both the ulnar forearm and radial forearm flaps provide thin, fasciocutaneous, vascularized tissue with acceptable aesthetic outcomes when surfacing external anatomy.…”