61.2 Injuries of the lips, the gums, and the tongue

When you suture a patient’s lip: (1) Try to align the border between the skin and the vermilion part of his lip exactly. If you fail, he will look very ugly. (2) Try to prevent a scar forming, because this may notch the margin of his lip, shorten it, and evert it. Try also to restore his Cupid’s bow and his philtral columns. Mark them before you infiltrate or manipulate his wound, and align them with guide sutures before you infiltrate the rest of it.

His tongue can be injured if he is hit on the jaw when his tongue is out, or if he bites his tongue during a convulsion.

Figure 61.4: WOUNDS OF THE LIPS. A, shows the anatomy you should try to preserve in a wound of a patient’s nose and lips. Try especially to preserve his skin–vermilion border and his philtral columns. B, if a large piece of his lip is missing, suture his skin to his mucosa. C, and D, show the first suture placed in his skin–vermilion border. E, F, and G, show the sequence of steps in repairing a severe laceration of his lip. Note that the first stitch brings his skin–vermilion border together, and the second one is in his labial sulcus. With the kind permission of Peter London.