Oral Lacerations

Ovid: 5-Minute Sports Medicine Consult, The

Oral Lacerations
Brent H. Messick
Kevin E. Burroughs
  • Soft tissue injury in the orofacial area
  • Typically results from a direct blow to the mouth resulting from a fall or impact by an opponent or object
  • Lacerations may be an indirect result of an individual biting the cheek or lip.
  • Most common in contact sports not requiring face protection (basketball, hockey, soccer, baseball, wrestling)
  • Other at-risk sports include bicycling, in-line skating, and gymnastics.
  • Children are most susceptible between the ages of 7 and 11.
As high as 1.06/100,000 athlete exposures (1)
1.4/10,000 athlete exposures in football and 18.3/10,000 in basketball; 58–75% of these injuries are soft tissue lacerations (2).
Risk Factors
  • Participation in collision or contact sports
  • Not using a mouth guard
Commonly Associated Conditions
  • Fracture of the mandible, dental arch, palate
  • Dental luxation or avulsion
  • Tooth fracture
  • Temporomandibular joint (TMJ) trauma
  • Vessel injury
  • Nerve transection
  • Salivary gland duct injury
  • Determine where and how the injury was sustained. Common in sports, but also seen as result of fighting, assault, and abuse.
  • Determine areas of numbness or loss of muscle control to evaluate for nerve injury.
  • Determine last tetanus immunization, as wounds often are contaminated from the environment as well as from the oral cavity.
  • Sensitivity of teeth (assess for occult dental trauma)
Physical Exam
  • Significant hemorrhage due to the abundant blood supply in the face and maxillofacial areas
  • Visible defects with “through and through” lacerations (lacerations involving all layers: Mucosa, muscular, SC, and skin)
  • Patient distress
  • Head and neck examination for signs of neural injury
  • Palpate over TMJ joint to evaluate for subcondylar mandibular fracture
  • Test mobility of jaw
  • Evaluate laceration for length and depth as well as for affected structures, including nerves and vessels (transected nerves need to be referred for surgical repair)
  • Buccal lacerations need to be evaluated for parotid salivary flow from the Stenson's duct. Parotid orifice is located opposite the maxillary 1st molar. Saliva should flow from opening when parotid gland is palpated (disruptions of the duct should be referred for repair).
  • Evaluate for normal occlusion of the teeth. Dental examination should be performed to check for fractured, loose, or avulsed teeth.
Diagnostic Tests & Interpretation
  • If there is a clinical suspicion of a fracture or foreign body such as a tooth fragment, appropriate studies should be ordered: Panorex for teeth, plain radiographs for foreign bodies or CT for facial fractures, etc.
  • Bone fixation/repair, if needed, should be performed before soft tissue closure.
Differential Diagnosis
  • Contusion
  • Abrasion
  • Dental trauma (luxation, avulsion, fracture)
Ongoing Care
Follow-Up Recommendations
  • Laceration associated with fracture or involving nerves or salivary ducts should be referred for definitive care as soon as possible.
  • Refer dental trauma to a dentist or oral surgeon.
  • Patients receiving antibiotics should be rechecked in 48 hr to ensure improvement and antibiotic susceptibility.
1. Labella CR, Smith BW, Sigurdsson A. Effect of mouthguards on dental injuries and concussions in college basketball. Med Sci Sports Exerc. 2002;34:41–44.
2. Flanders RA, Bhat M. The incidence of orofacial injuries in sports: a pilot study in Illinois. J Am Dent Assoc. 1995;126:491–496.
Additional Reading
Echlin P, McKeag DB. Maxillofacial injuries in sport. Curr Sports Med Rep. 2004;3:25–32.
Echlin PS, Upshur RE, Peck DM, et al. Craniomaxillofacial injury in sport: a review of prevention research. Br J Sports Med. 2005;39:254–263.
Ranalli DN, Demas PN. Orofacial injuries from sport: preventive measures for sports medicine. Sports Med. 2002;32:409–418.
Ud-din, Zia and Aslam, Musarrat. Should minor tongue lacerations be sutured in children. Best Evidence Topics. 2007. Accessed 10/05/2009. http://www.bestbets.org/home/bets-introduction.php
Using mouthguards to reduce the incidence and severity of sports-related oral injuries. J Am Dent Assoc. 2006;137:1712–1720.
  • 873.60 Open wound of mouth, unspecified site, uncomplicated
  • 873.61 Open wound of buccal mucosa, uncomplicated
  • 873.62 Open wound of gum (alveolar process), uncomplicated

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