Disease of lip

‫ عائشه الجمعي‬.‫د‬
Classification of Lip Disorders

 Developmental
 • Congenital lip pits
 • Commissural lip pits
 • Double lip
 • Cleft lip and cleft palate
 Cheilitis
 • Glandular cheilitis
 • Granulomatous cheilitis
 • Angular cheilitis
 • Allergic-contact cheilitis
 • Eczematous cheilitis
 • Actinic cheilitis
 • Exfoliative cheilitis
 • Plasma cell cheilitis
 • Cheilitis due to drugs
 • Cheilitis simplex
 Miscellaneous
 Acanthosis nigricans
 Carcinoma of lip
 Chronic lip fissure
 Chapping of lips
 Actinic elastosis
 Lip ulcers due to caliber persistent artery.
Anatomy of lip
Developmental Disorders of Lip

 Congenital Lip Pits (Paramedian lip pits)

 Etiopathogenesis:
 Hereditary
 Incomplete union
 Clinical Features
Sex predilection
Site
Appearance
 Association (Van der woude’s syndrome)
popliteal pterygium syndrome

 Management
 Surgical excision: It is done for cosmetic purpose
1 Commissural lip pits: common 1-20%, ↑adults
▪ Autosomal D: in some cases
▪ Uni/bilateral blind tracts at angle of lip, up to 4 mm
▪Saliva
 Pathogenesis: failure of normal fusion of embryonal and
mandibular processes
 Management
 Surgical excision: It is indicated only in severe condition,
secondary infection can occur
Cleft Lip
 Acanthosis Nigricans
Definition
Pigmented papillomatous cutaneous lesion that
occasionally involves the lips.
Acanthosis nigricans may be a manifestation of a
gastrointestinal malignant tumor.

Etiology: unknown

Prevalence: Rare

Clinical Aspects
Multiple papillomatous lesions of the labial
mucosa; in contrast to the cutaneous lesions,
pigmentation of the labial lesions is rare

Treatment: Treated underlying malignancies

Acanthosis Nigricans
 Cheilitis Fissurata (Fissured Lip)
It represents a persistent linear ulcer in the sagittal plane

The cause of the fissuring is actually unknown

with Down syndrome, Crohn disease, or orofacial granulomatosis

Occur in adults

Clinical Aspects
Superficial, often painful fissuring of the mucosa,
usually in the midline

Treatment
Since there is hardly any tendency for spontaneous
healing, surgical correction may be considered.
Cheilitis: It is inflammation of lip
 Glandular Cheilitis
 It is an uncommon condition in which lower lip becomes enlarged,
firm and finally everted
 Etiology
 Sun exposure
 Hereditary
 Salivary gland inflammation

 Types
 Simple
 Superficial suppurative type
 Deep suppurative type
 Clinical Features:
 Age: It is more common in adults
 Site
 Symptoms: Enlargement of labial salivary glands occurs which can be
nodular
 Signs: Orifices of secretory ducts are inflamed and dilated appearing as
small red macules over the mucosa
 When the lip is squeezed, mucopurulent secretions can be expressed
from these ductal openings
 Volkmann’s cheilitis: It is more severe suppurative
form of glandular cheilitis
 Malignant transformation
 Management
 Vermilionectomy or lip shave
Cheilitis Glandularis
Granulomatous Cheilitis or
Orofacial Granulomatosis
 Definition
 Inflammatory-like swelling of the upper or lower lip
 Etiology
 Local causes
 • Chronic oral/dental infection
 • Embedded foreign material
 • Allergy
 Systemic causes
 • Crohn’s disease
 • Sarcoidosis
 • Tuberculosis.
 Melkersson- Rosenthal syndrome
 Clinical Features
 Age and sex: It is seen in adults as well as in children and there is female
predilection

 Symptoms
 There is diffuse swelling of the lips, especially the lower lip
 Cheilitis granulomatosa may run a recurrent clinical course
 Palpation: The swelling is usually soft and exhibits no pitting on
pressure. Swelling eventually becomes firmer and acquires
the consistency of that of hard rubber

 Clinical Differential Diagnosis

 Cheilitisglandularis
 Angioedema
 Amylodosis
 Sarcoidosis
 Crohn’s disease
 Lymphangioma
Treatment
 In persisting cases, local application of corticosteroids
may be considered
 intralesional injections of corticosteroids
 In severe cases, surgical correction may be indicated
(Cheiloplasty)
Angular Cheilitis
It is also called as ‘Perleche’, ‘angular
cheilosis’ ‘cheilocandidiasis
 Definition
 Inflammatory-like lesion of the commissures of the lips

 Causes
 • Microorganisms
 vitamin B deficiency or folic acid defi ciency
 Mechanical factors: Overclosure of jaws
 Diseases of skin: Atopic dermatitis
 Other factors: Hypersalivation, Down’s syndrome
 Clinical Features
 • Age: It occurs in young children as well as in
adults.
 • Symptoms: It is characterized by feeling of dryness
and a burning sensation at the corners of the
mouth.
 • Appearance: It is usually a roughly triangular area
of erythema

 Treatment
 Adjustment of the vertical height of the jaws, if
applicable.
 Local application of antifungals may be helpful
 Fusidic acid ointment
 Cheilitis Exfoliativa
 It is also called as Factitious cheilitis. It is a chronic
superficial inflammatory disorder of the vermilion
border of lips characterized by persistent scaling
and flaking

 Causes
 Chronic injury
 Personality disorders

 Clinical Features
 • Age and sex
 Site: The process starts in the middle of the lower
lip and spreads to involve the whole of the lower
lip or both the lips
 there may be pain or burning as well
 There is erythema of perioral skin
 DD: allergic contact cheilitis and atopic cheilitis

 Diagnosis
 • Clinical diagnosis: Scaling, crusting with perioral skin
 erythema will aid to diagnosis.
 Management
 • Reassurance and psychotherapy
 corticosteroids, tacrolimus ointment
 Hydrocortisone can be combined with iodoquinol (antibacterial and
antimycotic) cream
Plasma Cell Cheilitis
 It is an idiopathic benign inflammatory condition
characterized by dense plasma cell infiltrate in the
mucosa
 Clinical Features
 • Site: lower lip
 It presents as circumscribed patches of erythema, usually
on the lower lip in elderly persons

 Diagnosis
 • Clinical: Not possible.
 • Laboratory: On histopathological examination, plasma
cell can be seen.
 Management
 It responds to topical application of powerful steroids
 Drug-induced Cheilitis
 Hemorrhagic crusting of the lips is a feature of Steven Johnson
syndrome, which is commonly caused by drugs but, cheilitis can
occur as an isolated feature of a drug reaction- either as a
result of allergy or a pharmacological effect

 The aromatic retinoids, etretinate and isotretinoin cause dryness and

cracking of lips in most patients.
Allergic contact cheilitis
 Allergic contact cheilitis is an exogenous type of
eczematous cheilitis caused by a hypersensitivity reaction
type IV to topical allergens such as cosmetics, lipsticks or
even toothpastes,
 mouthwashes and various foods.

 It appears as a diffuse erythema, papules, cracks, or

fissures.
 It is associated with an itching or burning sensation on
both lips, and is resolved as soon as the allergen
withdraws.
 Cheilitis simplex ) chapped lips(
 It appears whenever the patient is exposed to cold or hot weather,
as his lips tend to become drier under these extreme situations.

 It is characterized by cracking, fissuring and peeling on both lips

and gradually by crusting and bleeding.

 D.D:
 Exfoliate cheilitis? Gender- stress
 actinic cheilitis? Age- cause- reversible vs irreversible
cheilitis actinica

 Definition: Inflammatory-like, premalignant disease of the lips

caused by excessive exposure to sunlight.

 Some pathologists only report a diagnosis of cheilitis actinica when

there is epithelial dysplasia

 Chronic sun exposure: It is the main cause, so it usually occurs in hot,

dry regions, in outdoor workers and in fair skinned people
 Clinical Features
 Site: The lower lip is more commonly affected than the upper lip
 Age and sex distribution: It is more commonly seen in adult patients

 Signs: In the early stages, there may be redness and edema

 but later on, the lips become dry and scaly

 With the passage of time, these scales become thick and horny with distinct
edges

 Margin: There is blurring of the margin between vermilion

 zone and cutaneous portion of lip.

 Malignant transformation

 Treatment
Keratoacanthoma

 Definition
 Benign, usually fast-growing, crust-forming lesion of
the skin. Mucosal involvement is rare and is limited
to the vermillion border of the lips.

 Clinical Aspects
 Usually a solitary, somewhat pedunculated, often
fast-growing and painful swelling with a central
crater in the surface
 Carcinoma of Lip
 Squamous cell carcinoma is the commonest malignancy
to affect the vermilion zone. It occurs in light skinned
people who have chronic exposure to sunlight

 Clinical Features
 • Age and sex distribution:
 There is peak appearance in 6th and 7th decade of life. It
is more common in males as compared to females.

 It often commences as a small area of thickening,

 induration and ulceration or irregularity of the surface
 Mucocele
 Definition
Retention of mucous from the (minor) salivary
glands of the oral mucosa

 Etiology
 Mucous retention is the result of traumatic injury
of the orificium of the excretory ducts, causing
either retention of saliva in the ductal system
(“retention phenomenon”) or rupture of the
salivary gland duct, resulting in mucous
extravasation (“extravasation phenomenon
Lipoma of the lower lip Traumatic ulcer in a child after a mandibular
block with local anesthetics

Granular cell tumor on the upper lip in a

4-year-old child