Oral Lacerations Lecture Notes PDF

DH 410 EMERGENCIES IN DENTAL PRACTICE SELF-STUDY: INADVERTENT LACERATION OF TISSUES IN THE ORAL CAVITY Skin Anatomy  Epidermis  keratinized squamous epithelium  Avascular  Dermis  dense, fibro-elastic tissue  highly vascular  cells of dermis mainly f...

DH 410 EMERGENCIES IN DENTAL PRACTICE SELF-STUDY: INADVERTENT LACERATION OF TISSUES IN THE ORAL CAVITY Skin Anatomy  Epidermis  keratinized squamous epithelium  Avascular  Dermis  dense, fibro-elastic tissue  highly vascular  cells of dermis mainly fibroblasts responsible for elaboration of collagen, elastin, ground substance  Subcutaneous layer (superficial fascia)  connects dermis to underlying tissue  contains variable amounts of adipose tissue Wound Healing  Stages  hemostasis  inflammation  epithelialization  fibroplasia  contraction  scar maturation Wound Healing  Inflammation  serves to remove bacteria, foreign debris, and devitalized tissue – a biologic debridement  if this stage is prolonged (from infection, foreign material, etc.) will get persistent inflammation and result in poor wound healing Wound Healing  Epithelialization  insutured wounds, surface of wound develops epithelial covering impermeable to water in 24-48 hours  Eschar (dead tissue) and surface debris impair this process by inhibiting the migration of the epithelial cells Wound Healing  Fibroplasia  by fourth day fibroblasts begin synthesizing collagen, initiating scar formation  characterized clinically by pebbled red tissue in wound base Wound Healing  Contraction  movement of skin edges toward center of defect, primarily in direction of underlying muscle  everting skin edges at time of repair accounts for the subsequent wound contraction Wound Healing  Scar Maturation  amount of scar tissue influenced by physical forces acting across wound  strength of wound increases rapidly from day 5-17, more slowly for additional 14 days, and further collagen remodeling / maturation for 2 years  strength of scar tissue never quite reaches that of unwounded skin Wound Evaluation – History American College of Emergency Physicians: Clinical policy for the initial approach to patients presenting with penetrating extremity trauma. Ann Emerg Med Vol 33 No. 5 May 1999  Identify all extrinsic and intrinsic factors that jeopardize healing and promote infection  mechanism of injury  time of injury  environment in which wound occurred potential contaminants, foreign bodies  species of animal if bite  patient’s medical problems / immune status  tetanus immunization status  handedness / vocation (daily activity) Wound Evaluation - History  Risk Factors for wound infection (Singer et al. Risk factors for infection in patients with traumatic lacerations. Academic Emergency Medicine. July 1, 2001; 8(7): 716-20)  older age  diabetes  laceration width  presence of foreign body Specific Wounds – Face  high vascularity therefore low incidence of infection  debride minimally to preserve normal facial contours  be more aggressive with layered closure Specific Wounds - Lips  Anatomy  skin, vermilion border, vermilion, oral mucosa  obicularis oris  Always inspect intraoral and mucosal lip wounds for foreign bodies – esp. teeth and teeth fragments  Lacerations through vermilion border  use traction to the lips place first stitch at vermilion border – need perfect alignment  then repair obicularis oris  then repair skin and remainder of lip Specific Wounds - Lips  Through and through lacerations 3 layer closure 1st– mucosal layer with rapidly absorbable suture 2nd – orbicularis oris 3rd – skin Specific Wounds – Intraoral  Irrigation as per normal  lacerations of buccal mucosa and gingiva heal without repair if wound edges not widely separated  Small (