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4. Severe Septal Mucosal Lacerations or Hematomas

In cases of severe septal mucosal lacerations or hematomas, septal

splints are advocated. Prefabricated Doyle splints and hand-cut silicone

sheets are both viable options.

5. Extensive Soft Tissue Undermining

If extensive soft tissue undermining has occurred and/or the threat of

subcutaneous dead space exists, the soft tissue envelope should be

taped and dressed in a post-rhinoplasty fashion.

F. Lips

1. Wound Examination

Examine for underlying fractures, loose dentition, malocclusion, or other

oral cavity injury.

2. Wound Closure

Close wounds in multiple layers.

a. Mucosa

Close mucosa with resorbable sutures (i.e., chromic, Vicryl™, Vicryl

Rapide™).

b. Orbicularis Oris Muscle

Reapproximate laceration of the orbicularis oris muscle as a separate,

central layer. In our opinion, polydioxanone suture material is the

preferred option. The monofilament glides through muscle without

tearing, minimizes scar formation, and provides a longer-lasting, strong,

yet resorbable option for muscle repair.

c. Red and White Lips

Red and white lips should be closed as independent subsites. Red lip

should be closed with chromic or Vicryl™ sutures, with attention to

realignment of the “dry line”—the interface between the wet and dry

red lip.

3. Reapproximation of Landmarks

a. Vermillion Border

The vermillion border is an important aesthetic boundary. Great care

should be taken to reapproximate this line. A simple, precise, single 6-0

suture should be place squarely at this line. Some surgeons advocate

using silk suture material here, because of its soft quality and favorable

“lie.” However, fast-absorbing gut suture material is equally effective at

this site, particularly in children where suture removal itself may be

traumatic.