A 4-year-old child has fallen against a climbing frame while running in a park. She has lacerated her upper lip and loosened two upper front teeth.
1. what are the key points of the history and examination
2. what is the principles of management.
1. A complete history is required but it is also important to find out the time of the accident; any loss of consciousness or headache, nausea or vomiting since the accident; last food and drink, in case a general anaesthetic is required; and tetanus
status as the injury occurred outside. The usual oral and facial examination is required plus any evidence of an injury other than facial (facial bony margins,
eyes, bruising, etc.), depth of lip laceration and involvement of vermilion border, any missing teeth or tooth fragments, degree of mobility of involved teeth and any interference with occlusion.
2. The first stage in management will be reassurance of the child and parents. Wound cleaning and closure is likely to need general anaesthesia given the age of
the patient, who should, therefore, be admitted to hospital. Attempt to use resorbable sutures to avoid difficulty of removal. If the primary teeth are sufficiently mobile to be a threat to the airway when the child is sleeping, or if they are interfering with the occlusion, then they should be extracted at the same time as the laceration is sutured. Otherwise, no treatment is indicated other than recommending a soft diet and prescribing analgesia.