Answer
Lips are well innervated and very sensitive to pain. They can be difficult to anesthetize locally. In addition, local infiltration of anesthesia into external lip wounds often causes swelling and distortion of original landmarks.
Performing regional nerve blocks when possible can lead to optimal cosmetic and anesthetic results. [9] To anesthetize the lower lip, perform a mental nerve block; for the upper lip, perform an infraorbital nerve block (see the images below).
Pre-anesthetizing the mucosal area with a topical anesthetic 3 minutes prior to infiltrative injection is recommended.
For intraoral wounds, nerve blocks may not always be as effective. In these cases, consider further local anesthesia.
In small or uncooperative children, procedural sedation is highly recommended because of the importance of an immobile field.
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Equipment for the anesthesia, irrigation, and closure of a lip laceration.
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Lip laceration involving the lower vermilion border.
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Identification of intraoral skin laceration.
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Lip laceration involving the upper vermilion border.
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Deep intraoral lip laceration that needs repair.
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Technique for extraoral infraorbital nerve block.
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Intraoral approach for infraorbital nerve block.
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Placement of the first suture through the vermilion border.
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Assessing for mobile or broken teeth.
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Further inspection of the anesthetized wound reveals a through-and-through laceration.
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Extraoral approach to close the deep layer.
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Wound approximation after 2 deep sutures are placed.
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First suture aligning the vermilion border.
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Placement of intraoral skin suture with buried knot.
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Closure of an intraoral skin laceration.
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Closure of an intraoral laceration.
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Intraoral approach to close the deep layer.
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Wound approximation after placement of deep muscular sutures.
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Placement of the first suture through the vermilion border.
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Placement of the first suture through the vermilion border.
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Complete closure of the facial skin.
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Complete closure of the facial skin.
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Illustration of the upper and lower vermilion border.
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Areas of regional nerve blocks for the lips.
