Wounds of the oral mucosa are a high-incidence occurrence in the emergency department (Armstrong, 2000). They are particularly frequent in children (Torres-Lagares et al., 2012). The usual treatment consists of suturing the mucosa with simple stiches using resorbable braided threads, leaving the knot above the suture line and in contact with the oral cavity (Gunduz, Celenk, & Kayipmaz, 2004). This technique causes discomfort to patients because of the continuous rubbing that may occur. It may also interfere with ingestion and phonation processes, leading to potential complications such as loosening of the knot and even wound dehiscence (Politis, Schoenaers, Jacobs, & Agbaje, 2016). This article aims to describe a very simple suturing technique that allows for a stable wound closure and avoids these inconveniences.
SURGICAL TECHNIQUE
The first step in managing this kind of injury consists of obtaining a detailed medical history and physical examination to establish the depth of the wound and the presence of concomitant complications. Local anesthesia is administered and the wound is irrigated. Closing the wound with inverted stitches and burying the knots in the submucosa allow the wound to be closed without leaving knots in the oral cavity. This is achieved using a 4-0 fast absorbing braided suture and by first passing the needle from the submucosa (Figure 1) and extracting it through the epithelium of the oral mucosa. Then, the needle is introduced under the opposite epithelial edge and the submucosa and tied (Figures 2 and 3). Thus, the knot remains buried and is not in direct contact with the oral cavity and tongue.
The patient should be kept on a liquid and soft food diet for 24-48 hr and instructed to rinse the mouth with antiseptic mouthwash after every meal.
DISCUSSION
This simple suturing technique helps avoid potential complications that may arise from leaving the knot in direct contact with the oral cavity. Burying the knot in the submucosa reduces discomfort and adverse events such as loosening of the suture and wound dehiscence, which may be caused by rubbing the tongue against the knotted sutures in the oral cavity. When using this technique, a higher amount of resorbable material is left in contact with the wound bed, and this may theoretically induce a greater inflammatory reaction as the suture is absorbed (Balamurugan, Mohamed, Pandey, Katikaneni, & Kumar, 2012).
CONCLUSIONS
Inverted suturing of wounds in the oral mucosa is a simple technique that may reduce complications such as suture loosening and wound dehiscence, while increasing patient comfort.
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