- by Dr Santosh K
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- Aug 23 2017
What is suturing of oral mucosa?
Because of the substantial supply of blood vessels to the soft tissues of the mouth, effect injuries often lead to unexpected hemorrhages that send patients to the emergency ward with relatively insignificant wounds. Blunt injury to the face can cause secondary lacerations of the lips, buccal mucosa, frenulum, tongue and gingiva. Active bleeding usually stops by the time a patient with a minor lesion has reaches the emergency ward.
What to do:
Provide proper tetanus protection and check for related injuries such as loose teeth, facial or mandibular fractures.
When only small lesions are present and only minimal widening of the wound occurs compassion and simple aftercare is all that is needed. Let the patient know the wound will become somewhat painful and covered with pus over the next forty eight hours and tell him to rinse with lukewarm water after each meal and every one to two hours while awake for at least a week.
If there is prolonged bleeding, the edges of the wound significantly widen or there is a fold or deformity when there is contraction of the underlying musculature, the wound is be anesthetized cleansed rigorously with saline and loosely approached using a 4-0 or 5-0 absorbable suture. Use of conscious sedation is considered when suturing children who cannot cooperate. When trying to suture the tongue of a small child or intoxicated adult, a traction stitch or special rubber-tipped clamp can be very helpful. The same aftercare as above applies.
When the exterior surface of the lip is wounded, any separation of the underlying musculature must be restored with concealed absorbable sutures. To avoid an unattractive scar when the lip heals, exact skin estimation is very crucial. The vermilion border is firstly estimated, making this the key suture. Fine non-absorbable suture material is most suitable for the skin surfaces of the lip while a fine absorbable suture is quite acceptable on the mucosa and vermilion.
For deep lesions of the lip or mucosa or any sutured lesion in the mouth, medications are prescribed for about 3 to 4 days to prevent deep tissue infections. Medication for managing pain is also advised.
The patients are advised to return in forty eight hours for a re-evaluation of the wound.
After the repair soft foods and cool liquids beginning 4 hours is recommended.
What not to do:
Patient is advised not bother to restore a simple laceration or a forcible tearing of the frenulum of the upper lip. It will heal quite well on its own.
A non-absorbable suture material on the gingiva, tongue, or buccal mucosa is not used. There is no benefit and suture removal on a small child will be an unpleasant struggle at best.
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