Resident Manual of Trauma to the Face, Head and Neck

4. Severe Septal Mucosal Lacerations or Hematomas In cases of severe septal mucosal lacerations or hematomas, septal splints are advocated. Prefabricated Doyle splints and hand-cut silicone sheets are both viable options. 5. Extensive Soft Tissue Undermining If extensive soft tissue undermining has occurred and/or the threat of subcutaneous dead space exists, the soft tissue envelope should be taped and dressed in a post-rhinoplasty fashion. F. Lips 1. Wound Examination Examine for underlying fractures, loose dentition, malocclusion, or other oral cavity injury. 2. Wound Closure Close wounds in multiple layers. a. Mucosa Close mucosa with resorbable sutures (i.e., chromic, Vicryl™, Vicryl Rapide™). b. Orbicularis Oris Muscle Reapproximate laceration of the orbicularis oris muscle as a separate, central layer. In our opinion, polydioxanone suture material is the preferred option. The monofilament glides through muscle without tearing, minimizes scar formation, and provides a longer-lasting, strong, yet resorbable option for muscle repair. c. Red and White Lips Red and white lips should be closed as independent subsites. Red lip should be closed with chromic or Vicryl™ sutures, with attention to realignment of the “dry line”—the interface between the wet and dry red lip. 3. Reapproximation of Landmarks a. Vermillion Border The vermillion border is an important aesthetic boundary. Great care should be taken to reapproximate this line. A simple, precise, single 6-0 suture should be place squarely at this line. Some surgeons advocate using silk suture material here, because of its soft quality and favorable “lie.” However, fast-absorbing gut suture material is equally effective at this site, particularly in children where suture removal itself may be traumatic.

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