|Year : 2015 | Volume
| Issue : 2 | Page : 103-105
Management of rare case of lip tear and extrusion of anterior mandibular teeth
KM Sangeetha1, B Srinivasa Sagar2, Rashmi G Chour3
1 Department of Pedodontics, College of Dental Sciences, Davangere, Karnataka, India
2 Department of Anatomy, A J Institute of Medical Sciences, Mangalore, Karnataka, India
3 Department of Pedodontics, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
|Date of Web Publication||14-May-2015|
K M Sangeetha
Department of Pedodontics, College of Dental Sciences, Davangere - 577 004, Karnataka
Source of Support: None, Conflict of Interest: None
The occurrence of combined injury involving both extrusion and lower lip injury is extremely rare. A simple review of the medical literature shows that no article up to this date has reported the prevalence of the both the injuries in mandible. And an ideal treatment of this type of dental trauma is not well established. Hence, our objective is to relate several challenges that the professional might have to deal with. In this case report, extruded 41 was replanted after 6 h and lower lip tear crossing vermilion border and extending 2 mm involving skin. The repositioned extruded teeth did not demonstrate ankylosis, lower lip healed with minimum scar. Proper treatment planning and follow-up care can lead to a successful outcome.
Keywords: Extrusion, lip tear, vermilion
|How to cite this article:|
Sangeetha K M, Sagar B S, Chour RG. Management of rare case of lip tear and extrusion of anterior mandibular teeth. J Sci Soc 2015;42:103-5
| Introduction|| |
Trauma is an experience that is emotionally painful, distressful or shocking, which often results in lasting mental and physical effects. Trauma involves an event and a reaction or response that includes an overwhelming experience of helplessness or powerlessness. Human traumatic lip injuries, although uncommon, present major challenges in terms of reconstructive options and the outcome of surgical management. Since the lips have such centrally important esthetic and functional roles, successful maintenance of these roles after reconstruction is of paramount importance. The reconstructive techniques are usually varied, but the ultimate objectives of treatment are to achieve healing, function, and esthetics.  The case report mentioned here is rare case of trauma involving both extrusion of 41 and lower lip tear correction with best results. Where road traffic accident and human bite remained the major etiological factor for these injuries in developing countries here it was while playing cricket. Untreated extruded teeth and secondary healing of lip injury could have significant negative functional, esthetic, and psychological effect on children.
| Case report|| |
A 11-year-old boy was referred to dental hospital. As he was hit with the ball while playing cricket. On clinical examination, there was lower lip tear crossing vermilion border and extending 2 mm involving skin extruded 41 [Figure 1]. Patient was brought to the clinic 6 h after the time of injury. He had no relevant medical or family history. Inferior alveolar nerve block and buccal nerve block were given with Lidocaine HCl 2% + Epinephrine 1:100,000. First the tooth was replanted into the socket. Lip was managed using direct primary closure. Where, correct approximation and alignment of orbicularis muscle and vermilion border was done. Orbicularis oris muscle was repaired with 4-0 vicryl, intra oral mucous membrane was then closed with 4-0 chromic, and finally skin was closed using 6-0 nylon [Figure 2]. Semi rigid fixation was done with 41 using stainless steel wire and light cure resin. Patient was asked to maintain oral hygiene and be on soft diet. Antibiotics amoxicillin 500 mg metronidazole 500 mg, paracetamol 500 mg were prescribed for 5 days 8 hourly. Tetanus prophylaxis was introduced. After 1-week sutures were removed [Figure 3]. Root canal treatment was initiated with 41. Vitality testing and composite resin restoration was done with 11 and 21 as there was Ellis class II fracture because he had a history of fall 2 years back. By 2 nd week splint was removed and root canal treatment completed with 41 [Figure 4].
During 1 st year follow-up sessions were performed every 3 months, clinical examinations revealed normal gingiva, periodontal ligament (PDL) with 41. Light scar was seen with the lower lip [Figure 5]. Radiographic examination demonstrated normal root with no ankylosis or radiolucency [Figure 6].
| Discussion|| |
Definition: Partial displacement of the tooth axially from the socket; partial avulsion. The PDL usually is torn. Diagnosis: Clinical findings reveal that the tooth appears elongated and is mobile. Radiographic findings reveal an increased PDL space apically. General prognosis: In permanent mature teeth with closed apices, there is considerable risk for pulp necrosis and pulp canal obliteration. These teeth must be followed carefully.  Our case shows a successful treatment in 1-year follow-up period.
Lower lip was most prone to being bitten; this is consistent with the findings of previous work. The middle third of the lower lip was the most commonly bitten part.  Whereas in our case, it was due to a ball hit while playing cricket, where lip tear occurred along with tooth extrusion without alveolar fracture this is in agreement with Andreasen who says, if the lip absorbs and distributes the impact, the chance of crown fracture is reduced while the risk of luxation and alveolar fracture is increased. 
The management of the resulting lip defect from traumatic lip injury remains a significant reconstructive challenge, requiring meticulous preoperative planning and surgical technique to optimize the functional and cosmetic outcome. The main goals of reconstruction remain the restoration of oral competence, maintenance of oral opening, and the restoration of normal anatomic relations such that both the active (smile) and passive (form) cosmetic outcome is acceptable. 
Falls, and sport injuries, such as skiing, biking cricket, hockey, If immediate treatment of these injuries is to be considered, where soft tissues and mucosal remnants on mandibular are preserved, then primary suturing is indicated, whereas in late referral patients healing by secondary intention takes place, which is slow and accompanied with scar formation. In our case, lip injury healed with a minimal scar where some experience with hypertrophic scarring and keloid formation.
| Conclusion|| |
Though, it was late to visit after injury to the dental clinic. Treatment can be done according to the ADA guidelines with successful result, the repositioned extruded teeth did not demonstrate ankylosis, lower lip healed with minimum scar. Proper treatment planning and follow-up care can lead to a successful outcome. We advise for more awareness among school teachers and parents for correct handling of such cases immediately after injury.
| References|| |
Adeyemo WL, Taiwo OA, Adeyemi MO, Adewole RA, Gbotolorun OM. Pattern of presentation and management of lip injuries in a Nigerian hospital. Niger J Clin Pract 2012;15:436-41.
Guideline on Mangement of acute Dental Trauma; 20011. http://www.aapd.org/media/Policies_Guidelines/G_trauma.pdf [Last accessed on 2015 Apr 18].
Asuku ME, Adeola DS, Obiadazie AC, Ononiwu CN. Human bites of the face with tissue losses in cosmopolitan northern Nigeria. Niger J Surg Res 2006;8:123-7.
Andreasen JO. Etiology and pathogenesis of traumatic dental injuries. A clinical study of 1,298 cases. Scand J Dent Res 1970;78:329-42.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]