Lower lip avulsion

The lip avulsion started from the left canine tooth 304, and went all the way to the right side mandibular last molar (409) and the ventral border of the mandible (Fig.1). 

As we can see from this figure the exposed tissue as a consequence of the avulsion is edematous, swelled and forming a crust on surface proving the injury was at least one day old. On top of everything we found another unusual thing, namely an ectopic second deciduous incisor which was lying between the second and third left side lower incisors with about 3 mm distance towards ventral (Fig.2).

After proper sedation with a combination of Domitor (80 mg/kg) and Ketamine (2.5 mg/kg), and local mental nerve block completed with a local infiltration with Ubistezin (articaine) we proceeded with the operation. Firstly we properly rinsed the area with an antiseptic solution containing propolis (obtained from bees and known to have a strong antiseptic effect), poviodine and iodine ether. After that we continued by debriding the edematous crusted tissue with the aid of a scalpel blade all the way to bleeding healthy tissue.

We also loosened using a periosteal decolator and the scalpel blade the lower lip which was contracted because of dehydration as a consequence of external exposure. We insured there are no necrotic areas left uncleaned and proceeded in suturing the lower lip. We used a combination of U shaped sutures with simple interrupted sutures using Vycril 4.0 resorbable multithreaded material and passed most of the sutures interdentally and behind canini. We also used simple monolayer sutures to re-appose the lip mucosa. The final view is self explanatory (Fig.3 and Fig.4).

We instituted a moderate pain control protocol using a single dose of injectable Rymadil (2mg/kg) administered subcutaneously and antibiotherapy with Clindamycin (11mg/kg) per os for 7 days. After 2 days the owner states that the cat feels and feeds happily.

DDr. Camil Stoian Phd., Mag. Helene Widmann