Lesson

Soft-tissue injuries

Intra-oral, perioral and facial lacerations are all common occurrences in football. Athletes who are bleeding are not allowed to return to play for both their own safety and the safety of their opponents. As with other lacerations, proper debridement and – where indicated – a layered closure will help to ensure proper healing and a quick recovery.

Please refer to the four cases below to review the management of various soft tissue injuries.

Uncomplicated external laceration

This laceration includes a foreign body (tooth segment) that must be removed and retained for possible reattachment. Removal of any small salivary glands is good practice. The use of tissue adhesives – after closure with sutures – and ice to reduce post-operative swelling is often suggested.

Deep laceration/vermillion border

Any tear involving the vermilion border of the lip must be carefully closed to avoid a “step” in the border after healing. Closure should start by approximating the edges of the vermilion border. Deep lesions require a layered closure to minimise dead space and properly approximate the tissues. This deep layer should be thoroughly cleaned and then closed with resorbable sutures. Any small, unsupported saliva glands can be removed to promote healing. Once closed, external closure can begin with the vermilion border. Topical antibiotics, ice and NSAID are important. Oral antibiotics may be considered.

Intra-oral laceration/through-and-through

In any case where the intra-oral mucosa or tongue is lacerated, it is proper practice to close these lacerations to restore proper anatomy, reduce healing time and prevent infection. Many practitioners have been advised that, because one cannot “sterilise” the site prior to closure, these intra-oral lacerations should be left open to reduce the risk of post-operative infection. This is not true. Proper closure – often in combination with an antibacterial rinse – is the required treatment.

Degloving and gingival trauma

It is not uncommon for the gingival tissues to be stripped back, causing a “degloving” injury. As with other soft tissue injuries, these tissues should be properly cleaned and debrided and then closed to help retain both the proper anatomy and coverage of the tooth root and alveolus. Following closure, a periodontal pack might be placed, and topical antibacterial rinses along with a soft diet are indicated.

Click on the following images to see some other examples of soft tissue lacerations.

  • An uncomplicated laceration

  • The uncomplicated laceration following treatment

Some sport physicians have been trained to leave many intra-oral lacerations open because the area cannot be rendered reasonably bacteria-free prior to closure. To promote proper healing and to retain proper soft-tissue architecture, most intra-oral and tongue lacerations should be sutured.

Dr Paul Piccininni

Sport, Cosmetic and Restorative Dentistry