Lip Disorders

Development of Lip
In the sixth week of intrauterine life, two medial nasal
processes merge in midline. This will form intermaxillary
segment which will give rise to center of upper lip.

In adult, center of upper lip forms philtrum. Philtrum is

bound laterally by two vertical ridges under the nostril.
Lateral part of upper lip fissure presents in maxillary
process. This may lead to cleft formation if it is not
covered by epithelium and fused. Upper lip is thus
formed from one-third medial nasal process and two-
third maxillary process.
 Anatomy of the lip
Mucocutaneous junction: lips are
fleshy folds lined by skin externally
and mucous membrane internally.
The upper and lower lips close along
the red margin which represents the
mucocutaneous junction.
Surface: the lips are covered with
skin on the external surface and
mucous membrane on the inner
surface, which has profuse salivary
glands.
Oral cornmissure: it is the angle
where the upper and lower lip meets.
 Anatomy of the lip
Content: each lip mainly
consists of bundles of striated
muscle, orbicularis oris,
superficial fascia and sub
mucosa. The skin of the lip
contains sweat glands, hair and
sebaceous gland. The dermal
papillae are numerous, with rich
capillary supply, which produce
reddish pink color of the lips.
Vermilion zone: it is the
transitional zone between the
skin and the mucous membrane.
 Classification of Lip
Developmental Disorders:

Cheilitis

Miscellaneous

Malignancy
Congenital lip Glandular Chapping of Carcinom
pits cheilitis lips a of lip
Commissural Granulomatou Actinic
lip pits s cheilitis elastosis
Double lip Angular Lip ulcers due
Cleft lip and cheilitis to caliber
cleft palate Contact persistent
cheilitis artery
Eczematous
cheilitis
Actinic
cheilitis
Exfoliative
cheilitis
Plasma cell
cheilitis
Cheilitis due
to drugs
Developmental Disorders of Lip

Congenital
Double lip
lip pits

Commissural Cleft lip and

lip pits cleft palate
 Congenital Lip Pits
o It is also called as 'paramedian lip pit or congenital
fistula'.
oEtiopathogenesis
Hereditary: it is inherited as an
autosomal dominant trait.
Notching of lip: there is notching
of lips at an early stage of
development with fixation of
tissues at the base of the notch.
Incomplete union : it may occur
due to failure of complete union of
embryonic sulci of the lip,
resulting in persistent lateral sulci
on the embryonic mandibular
 Congenital Lip Pits
o Clinical Features
Sex predilection: it is more commonly seen in females.
Site: it is common on vermilion border of either side of midline. It is most
commonly seen on lower lip. Lip pits or fistula is unilateral or bilateral depression.
Size: it may be upto 3-4 mm in diameter and may extend as deep as 2 cm.
Appearance: lips,some times appear swollen, accentuating the appearance of the
pit.
Palpation: on palpation, sparse mucus secretion may be visible from the base of
the lip-pit which occurs due to involvement of underlying minor salivary glands.
o Syndromes associated
congenital lip pits may occur in association with Van der Woude's syndrome (cleft
lip, cleft palate and congenital lip pits).
Another syndrome is associated with it is popliteal pterygium syndrome which also
includes Popliteal webbing (pterygia), cleft lip / cleft palate, genital abnormalities
and congenital bands connecting the upper and lower jaws (syngnathia).
 Congenital Lip Pits
Diagnosis
Clinical diagnosis: unilateral or bilateral depression on
vermilion border of lip will diagnose these conditions.
Management
Surgical excision: it is done for cosmetic purpose.
 Commissural Pits
Commissural lip pits are mucosal invagination occurring
at the vermilion border of lip.
Pathogenesis
They occur due to failure of normal fusion of embryonal
maxillary and mandibular processes. It is transmitted as
autosomal dominant transmission.
 Commissural Pits
o Clinical Features
Sex distribution: it is more common amongst males and
black people are affected more than white people.
Site: if it is unilateral, it occurs on the right side of the lip.
Appearance: commissural pit appears as aunilateral or
bilateral pit at the corner of the mouth on the vermilion
surface.
Size: size ranges from a shallow dimple to a tract measuring
4 mm in length and tissue slightly raisedabove the opening.
Palpation: in squeezing of the lip pit, small amount of saliva
can come out.
 Commissural Pits
Differential Diagnosis
Congenital lip pit: it may be associated with facial or palatal
cleft.
Management
Surgical excision: it is indicated only in severe condition,
where salivary secretion excessive and secondary infection
can occur.
 Double Lip
It is an anomaly characterized by a fold of excess tissue
on the inner mucosal surface of the lip. It may be
congenital or acquired because of trauma to the lip.
Pathogenesis
It occurs in 2nd or 3rd week of gestation due to persistent of
the sulcus between the pars glabrosa and pars villosa of the
lip.
 Double Lip
Clinical Features
Site: it usually occurs on inner aspect of upper lip.
Cupid bow appearance: when upper lip is tensed, double lip
resembles 'cupid bow'.
Syndromes associated:
it is associated with Ascher's syndrome which consists of double lip,
blepharochalasis (it is drooping of the tissue between eyebrow and
edge of the upper eyelid so that it hangs loosely over the margin of the
lid) and non-toxic thyroid enlargement.
Diagnosis:
Clinical diagnosis: cupid bow appearance is typical.
Management
Surgical excision.
 Cleft Lip and Cleft Palate
o It occurs along many planes as a result of fault or defect
in the development.
oDefinition
Cleft Lip: it is a birth defect that
results in a unilateral or bilateral
opening in the upper lip between
the mouth and the nose. It is also
called as harelip. It is wedge shaped
defect resulting from failure of two
parts of the lip to fuse into a single
structure.
Cleft palate: cleft palate is a birth
defect characterized by an opening
 Cleft Lip
o Etiology
Hereditary: it is one of most important factors to be considered in the etiology.
Genetic: the main possible mode of transmission is by a single mutant gene;
producing a large effect or by number of genes (polygenic inheritance), each
producing small effects which together create this condition.
Nutritional disturbances: riboflavin deficient diet can produce cleft palate
and cleft lip.
Developmental: physiological, emotional and traumatic stress during
developmental stages.
Defective vascular supply: defective vascular supply to the area may lead to
ischemia which in turn may lead to cleft formation.
Mechanical disturbances: here, the size of tongue may prevent union of the
parts.
Infection: infection and lack of inherent developmental force.
Miscellaneous: steroid therapy during pregnancy, alcohol, toxins in the
circulation.
 Cleft Lip
Classification of Cleft lip by veaus

Class I Class II Class III Class IV

A unilateral a unilateral a unilateral any bilateral

notching of notching of cleft of cleft of the lip,
vermilion vermilion with vermilion whether this is
border and it is cleft extending extending into
not extending into lip but not the floor of the complete or
into the lip. including the nose. incomplete.
floor of the
nose.
 Cleft Lip
o Clinical Features
There is nasal distortion as lip and nasal tissue pulls towards the attached side.
Hare lip: this term is used to apply for only median cleft lip. Hare lip is derived
from the rabbit who normally have cleft in the middle of their lip.
Unilateral cleft lip: a unilateral cleft involves only one side of the lip.
Bilateral cleft lip: cleft lip is present on the both sides of the midline.
Incomplete cleft: it extends for varying distances forward to the nostril, but not
upto the nostril. The upper part of lip has fused normally.
Complete cleft lip: it extends into nostril and palate is commonly involved. It is
often associated with flattening and widening of the nostril of the affected side.
o Symptoms
patient may be presented with difficulty in sucking. Patient also noticed defective
speech particularly with the labial letters B, F, M, P and V.
o Effect on tongue
there is soft tissue mass between the ends of the bone, uniting the tongue to the
lip, so that tongue is bound down.
 Cleft Lip
o Diagnosis
Clinical diagnosis- cleft ca be seen clinically on lip and palate.
Radiological diagnosis- cleft palate involving alveolus is seen clearly on radiography.
o Management
The complete rehabilitation of the condition requires a multi-disciplinary
approach.
Cheiloplasty: it is surgical closure of the lip. A general 'rule of tens' is used in
determining optimal timing of lip closure, i.e. 10 weeks of age, 10 pounds of body
weight and 10 gm of Hb. At the time of lip closure, when an infant is under general
anesthesia, an impression is made for the new obturator.
Cleft rhinoplasty: to improve nasal function and correct the distortion.
Speech therapy: speech therapy is given to improve pronounciation of the words.
PsFeeding plate: ychotherapy: psychological management is necessary.
to overcome initial feeding problems, feeding plate is used which acts as an obturator to
prevent nasal reflux.
 Cheilitis of Lip
Cheilitis: It is inflammation of lip. Various types of cheilitis are
described below.
Glandular Contact Exfoliative
cheilitis cheilitis cheilitis

Granulomato Eczematous Plasma cell

us cheilitis cheilitis cheilitis

Angular Actinic Cheilitis due

cheilitis cheilitis to drugs
 Glandular Cheilitis
o It is also called as cheilitis glandularis or orofacial granulomatosos.
It is an uncommon condition in which lower lip becomes enlarged,
firm and finally everted.
oEtiology
Sun exposure: glandular cheilitis can
occur due to chronic exposure to sun.
Hereditary: familial occurrence,
suggesting a hereditary pattern is also
present in glandular cheilitis.
Salivary gland inflammation:
inflammation of enlarged heterotopic
salivary glands can also be causative
factors.
Others : dust, tobacco use and emotional
disturbances also been reported in this
 Glandular Cheilitis
Types
(Historical)
Superficial
Simple Deep suppurative
suppurative

multiple, painless, (Baelz's disease) (cheilitis

pinhead sized it is characterized glandularis
lesions with by painless apostematosa,
central depression swelling, myxadenitis
and dilated canals induration, labialis)
are present. crusting superficial deep seated
ulceration of lip. infection with
abscess and fistula
tract that
 Glandular Cheilitis
o Clinical Features
Age: it is more common in adults but sometimes, it can also occur in
children.
Site: lower lip is involved more often than the upper lip.
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.
Palpation: viscid mucous secretion may seep from these openings of
everted hypertrophic lips after pressure given on the lip.
Volkmann's cheilitis: it is more severe suppurative form of
glandular cheilitis. The lip is considerably and permanently
enlarged and is subjected to episodes of pain, tenderness and
increased enlargement. The surface is covered by crust and scales
beneath which the salivary duct orifice may be discovered.
 Glandular Cheilitis
o Malignant transformation: it is apparently pre-malignant
and epidermoid carcinoma can be associated with it in 18 to
35% of cases.
o Diagnosis
Clinical diagnosis: everted hypertrophic lip with secretion after
pressure on lip.
o Management
Vermilionectomy or lip shave: due to high incidence of
associated malignancy, a vermilionectomy or surgical stripping of
lips has been recommended. It will give satisfactory cosmetic
results.
Surgical excision: if the lips are grossly enlarged, excision of an
elongated ellipse of tissue may be required.
 Granulomatous Cheilitis
o It is also called as 'Miescher's syndrome' or 'cheilitis grantilomatosa' .
o This condition is described in 1945 by Miescher. It is a condition of unknown
etiology that is not related to chelitis glandularis except by the similarity in the
clinical appearance of the two diseases.
 Granulomatous Cheilitis
Etiology

Local
Chronic oral / dental infection
Embedded foreign material
Allergy to cosmetics, foods, oral
causes hygiene products and dental
restorative materials.

Systemi
Chronic granulomatous disease
Crohn's disease
Sarcoidosis
c causes Tuberculosis
 Granulomatous Cheilitis
o Clinical Features
Age and sexit is seen in adults as well as in children and there is female predilection.
o Symptoms
There is diffuse swelling of the lips, especially the lower lip .
In some cases, an attack is accompanied by fever and mild constitutional symptoms
including headache and even visual disturbances.
Enlarged lip can create cosmetic problems, difficulty during eating, drinking or speaking.
o Signs: in some cases, scaling, fissuring and vesicles or pustules have been
reported.
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.
Lymph nodes: the regional lymph nodes are enlarged in some cases, but not always.
Skin: the skin and adjacent mucosa may be of normal color or erythematous.
o Syndrome: it is associated with Melkersson Rosenthal syndrome which
consists of fissured tongue and facial paralysis.
 Granulomatous Cheilitis
o Diagnosis
Clinical diagnosis: soft swelling of lip with fever, headache
and vesicle can be seen.
o Differential Diagnosis
Cheilitisglandularis: in this condition there is involvement of
labial salivary gland.
Angioedema: it is recurrent condition and swelling subsides
after giving antihistaminic.
Sarcoidosis: symptoms of fatigue and lethargy are present.
Crohn's disease: gastrointestinal symptoms are present in this
case.
Lymphangioma: it is congenital lesion.
 Granulomatous Cheilitis
o Management
Corticosteroid injection: repeated injection of triamcinolone
into the lips every few weeks may be effective. Before giving
steroids, topical anesthetics gels was applied over the lesion
and then 0.1% of triamcinolone acetonide injection is given.
This injection should be given weekly for 7 to 10 weeks.
Cheiloplasty: surgical stripping of lip can be done.
 Angular Cheilitis
o It is also called as 'Perleche', 'Angular cheilosis"Cheilocanclidiasis'.
o Causes
Microorganisms: particularly candida albicans, but also staphylococci and
streptococci.
Mechanical factors: overclosure of jaws such as in edentulous patients or in patients
with artificial denture which lack proper vertical dimensions. In it, folds are produced at
the corners of the mouth in which saliva tends to collect and the skin becomes
macerated, fissured and secondarily infected. Prognathism may give rise to similar
state of affair in young. The recurrent trauma from dental flossing may occasionally be
also implicated.
Nutritional deficiency: it can also occur due to riboflavin, folate and iron deficiency
with a superimposed fungal or bacterial infection. General protein deficiency can also
cause cheilitis.
Diseases of skin: atopic dermatitis involving the face is often ,associated with
angular cheilitis. The incidence also appears to be increased in seborrhoeic dermatitis.
Other factors: hypersalivation, Down's syndrome, large tongue and constant
dribbling being the contributory factors. A rare cause is the presence of a sinus of
developmental origin at the angles of the mouth.
 Angular Cheilitis
o 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 and edema at
one or more, commonly both the angles of mouth.
Signs: epithelium at the commissures appears wrinkled and somewhat
macerated .In time, wrinkling becomes more pronounced to form one or more
deep fissures or cracks which appear ulcerated but do not tend to bleed,
although a superficial exudative crust may form.
Rhagades: linear furrow or fissures radiating from the angle of mouth
(rhagades) are seen in more severe forms, especially in denture wearers.
o Prognosis : if the lesion is not treated, they often show a tendency for
spontaneous remission.
 Angular Cheilitis
o Diagnosis
Clinical diagnosis: triangular area or erythema with wrinkled macerated
mucosa at angle of mouth.
o Management
Removal of the cause: underlying primary cause should be identified
and treated.
Nutritional supplement: a course of vitamin B and iron supplements
are useful in these cases.
Fusidic acid ointment: it is used in staphylococcal infection. The lesions
should be swabbed first and then fusidic acid ointment or cream should
be applied at least four times a day.
Miconazole: miconazole may be preferred, if angular cheilitis is due to
candidiasis (cream applied locally together with an oral gel).
Gentian violet application: in some cases, it is useful.
 Eczematous Cheilitis
o The lips are involved secondary to atopic eczema but
possibility of contact dermatitis must also be
considered. The management of atopic eczema of the
lips is with emollient and topical steroids.
 Contact Cheilitis
o Definition
Contact cheilitis is an inflammatory reaction of the lips provoked by the irritants or
sensitizing action of chemical agents in direct contact with them.
o Causes
Lipsticks: they are composed of mineral oils and waxes which form the stick; castor oil as a
solvent for the dyes, lanolin as an emollient preservative, perfumes and color. The color includes
azo dyes and eosin, which is a bromofluorescein derivative. Sunscreen applied in the form of
lipstick can also cause contact cheilitis.
Lipsalves and other medicaments: lipsalves containing lanolin are frequently applied for
dryness or chapping. Phenyl salicylates and antibiotics have also been incriminated as a cause of
cheilitis.
Mouthwashes and dentifrices: essential oils such as peppermint, cinnamon, clove, spearmint
and bactericidal agents can cause cheilitis. Propolis, derived from resin and collected by bees, is a
well known sensitizer which has been used in toothpastes.
Dental preparations: mercury and eugenol may cause cheilitis in the absence of stomatitis.
Allergy to epimine containing materials used for crowns and bridges can cause cheilitis.
Foods: oranges, mangoes and artichokes are among the food plants which occasionally cause
allergic cheilitis and dermatitis of the skin around the lips.
Miscellaneous objects: metal hair clips, metal pencils, cobalt paint on blue pencil can also cause
cheilitis.
 Contact Cheilitis
o Clinical Features
Site: lipstick cheilitis is usually
confined to the vermilion
borders but more often extends
beyond that.
Signs and symptoms: there
may be persistent irritation and
scaling or a more acute reaction
with edema and vesiculation.
 Contact Cheilitis
Diagnosis
If acute eczematous changes are obviously present, the
diagnosis of contact cheilitis presents no difficulty. If an
allergic reaction is suspected, patch test can be carried
out.
Management
Topical steroids will give symptomatic relief but the
offending substance must be traced and avoided. Most
commonly used topical steroids use is 1% triamcinolone
acetonide.
 Actinic Cheilitis
It is also called as Actinic cheilosis.
Some other terms which use are
Farmer's lips or Sailor's lip as these
people are mom exposing to
sunlight.
o Definition
It is a pre-malignant squamous cell
lesion resulting from long-term exposure
to solar radiation and may be found at
the vermilion border of lip as well as
other sun exposed surfaces.
o Etiology
Chronic sun exposureit is the main
cause, so it usual::occurs in hot, dry
regions, in outdoor workers and fair
skinned people.
 Actinic Cheilitis
o Clinical Features
Site: the lower lip is more commonly affected than the upper lip as it receives
more solar radiation than the upper lip.
Age and sex distribution: it is more commonly seen in adult's patient. It is less
common in females due to sunscreen effect of lipstick and less common in blacks
due to protective effect of melanin.
Signs: in the early stages, there may be redness and edema but later on, the lips
become dry and scaly. If scales are removed at this stage, tiny bleeding points are
revealed. With the passage of time. these scales become thick and horny with
distinct edge. Patient can remove scales but it again reforms within few days.
Epithelium becomes palpably thickened with small grayish white plaques. Vertical
fissuring and crusting occurs, particularly in the cold weather.
Margin: there is blurring of the margin betwee vermilion zone and cutanous
portion of lip.
Superficial erosion: at times, vesicle may appear which rupture to form
superficial erosions. Secondary infection may occur.
Nodule formation: eventually warty nodules may form which tend to vary in size
with fluctuation in the degree of edema and inflammation.
 Actinic Cheilitis
o Signs of malignant transformation
The possibility of malignancy must always be
considered if following features are present;
Ulceration in actinic cheilitis.
A red and white blotchy appearance with an indistinct
vermilion border.
Generalized atrophy or focal areas of whitish thickening.
Persistent flaking and crusting.
Indurations at the base of keratotic lesion.
 Actinic Cheilitis
Diagnosis
Clinical diagnosis: redness, edema with history of chronic sun exposure will give clue to
diagnosis.
Management
Topical fluorouracil: for mild cases, application of 5% fluorouracil three times daily for 10
days is suitable. It produces brisk erosion but lips heal within 3 weeks. Application of 5-
fluorouracil to the lip will produce erythema, vesiculation, erosion ulceration, necrosis and
epithelialization. In some cases, podophyllin is also used.
CO2 snow: rapid freezing with CO: snow or liquid nitrogen on swab stick is used to remove
superficial lesions.
Vermilionectomy (lip shaves): under local anesthesia, the vermilion border is excised
by a scalpel and closure is then achieved by advancing the labial mucosa to the skin.
Laser ablation: carbon dioxide laser therapy has been used to vaporize the vermilion.
Good results with no postoperative paresthesia or significant scarring have been reported.
Electrodesiccation
o Prevention: following management, prevention of recurrence by regular use of
sunscreen lip salves is advisable. Liquid or gel waterproof preparation containing
para-aminobenzoic acid probably gives the best protection.
 Exfoliative Cheilitis
o It is also called as Factitious
cheilitis. It is a chronic superficial
inflammatory disorder of the
vermilion border of lips cha
racterized by persistent scaling
and flaking.
o Causes
Chronic injury: these cases may
occur due to repeated lip sucking,
chewing or other manipulation of
the lips.
Personality disorders: emotional
disturbance, psychological
 Exfoliative Cheilitis
o Clinical Features
Age and sex distribution: age of occurrence is seen in
younger group. Most cases occur in girls.
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.
Symptoms: the patient complains of irritation or burning and
can be observed frequently on biting or sucking the lips.
Signs: it consists of scaling and crusting, more or less
confined to the vermilion borders and persisting in varying
severity for months or years.
Perioral skin: there is erythema of perioral skin.
 Exfoliative Cheilitis
Diagnosis
Clinical diagnosis: Scaling, crusting with perioral skin
erythema will aid to diagnosis.
Management
Reassurance and psychotherapy: this is done to overcome
personality disorders. After this, many patients get relief.
Topical steroids: hydrocortisone cream is useful in resolving
some chronic cases in some patients.
Combination: hydrocortisone can be combined with
iodoquinol (antibacterial and antimycotic) cream can be used in
chronic cases of exfoliativecheilitis.
Others therapy: it includes topical silver nitrate,
salicylic acid, antibacterial and antifungal formulation.
 Plasma Cell Cheilitis
o It is an idiopathic benign inflammatory condition
characterized by dense plasma cell infiltrate in the
mucosa close to the body orifice.
oClinical Features
Site: it can affect penis,
vulva, lips, buccal mucosa,
palate, gingiva, tongue,
epiglottis and larynx.
Sign: it presents as
circumscribed patches of
erythema ,usually on the
lower lip in elderly persons.
 Plasma Cell Cheilitis
o Diagnosis
Clinical: not possible.
Laboratory: on histopathological examination plasma cell can
be seen.
o Management
It responds to topical application of powerful steroids
intradermal injection of triamcinolone.
 Drug-induced Cheilitis
Hemorrhagic crusting of the lips is a feature of steven
johnson syndrome which is commonly caused by drugsl
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
causes dryness and cracking of lips in most patients.
 Miscellaneous Disorders

Chapping of lips Actinic elastosis

Lip ulcers due to

caliber persistent
artery
 Chapping of the Lips
It is a reaction to adverse environmental conditions in
which keratin of the vermilion zone loose its plasticity.

o Causes: it is caused by
exposure to freezing cold or
to hot, dry wind, but acute
sunburns can cause very
similar changes.
 Chapping of the Lips
o Clinical features: lip becomes
sore, cracked and scaly. The
affected subjects tend to lick
the lips or to pick at the scales
which make conditions worse.
o Management: Management is
by application of petroleum jelly
and avoidance of the causative
environmental conditions.
 Actinic Elastosis
It is also called as 'Solar elastosis' or 'Senile elastosis'.
o Causes
Sunlight exposure-it is caused by prolonged exposure to UV
light. UV radiation can produce collagen degeneration in the
dermis and extent of this effect is dependent upon factors
such as the thickness of stratum corneum, melanin pigment,
clothing or chemical sunscreens.
 Actinic Elastosis
o Clinical Features
Site: it is seen on the labial mucosa exposed to sun.
Age: it occurs in elderly population.
Signs: white area of atrophic epithelium develops with underlying
scarring of the lamina propria.
Appearance: it includes leathery appearance, laxity with wrinkling
and various pigmentary changes.
o Clinical types- clinically, it is manifested in three forms:
Cutis rhornboidalis: thickened skin with furrow giving an
appearance of rhomboidal network.
Dubreuilh'selastoma: diffuse plaque like lesions.
Nodular elastoidosis: nodular lesion.
 Caliber Persistent Artery
o A caliber persistent artery is defined as an artery with a
diameter larger than normal near a mucosal or external
surface. In this condition, main arterial branch extends
upto the superficial tissue without reduction in the
diameter is present.
 Caliber Persistent Artery
o Clinical Features
Age and sex distribution: it is more commonly seen in adults as in
adults there is loss of tone in the connective tissue.
Site: either lip can involve or some patients have bilateral lesion.
Appearance: the lesion present as linear, arcuate or papular elevation
on the lip.
Ulcer formation: such artery in the lip may cause chronic ulceration
which can be mistaken for squamous carcinoma. The ulcer is attributed to
continual pulsation from the large artery running parallel to the surface.
Signs: pulsation can be seen in the lesion. Pulsation present in lateral
direction.
o Management
No treatment is necessary and some time, biopsy is to avoid the
misdiagnosis of the lesion.
 Carcinoma of Lip
o Squarnous cell carcinoma is the commonest
malignancy, affect the vermilion zone. It occurs in light
skinned who have chronic exposure to sunlight.
 Carcinoma of Lip
o Clinical Features
Age and sex distribution: there is peak appearance in and 7th
decade of life. It is more common in males compared to females.
Site: is most common on the lower lips of fair skinned people
and persons who work in outer climate.
Onset: it usually begins on vermilion border of lip to one side of
the rnidline and it may be covered crust due to absence of saliva.
Actinic cheilitis: it is preceded by actinic cheilitis which is
characterized by innocuous looking white plaque:-the lip.
o Symptomspatient may complain of difficulty in speech
difficulty in taking food and inability to close the mouth.
There is also pain, bleeding and paresthesia.
 Carcinoma of Lip
o Signs
It often commences as a small area of thickening, induration
and ulceration or irregularity of the surface.
In some cases, it commences as a small warty growth or
fissure on the vermilion border of the lip.
Crater like lesion having a velvety red base and rolled
indurated borders.
As the lesion enlarged, it takes papillary or an ulcerative form.
In untreated cases, there is total destruction of lip and
invasion of cheek, the gums and the mandible.
 Carcinoma of Lip
o Extent: papillary lesion grows slowly and infiltrared the
deeper relatively late whereas ulcerative growth invade
early.
o Metastasis: it may metastasize and it is usually
ipsilateral. Carcinoma of the upper lip metastasizes
earlier and more frequently than carcinoma of the lower
lip. It involves submaxillarv and submental nodes first
and then deep cervical nodes. Spread by direct
extension into surrounding structures and by metastasis
which is through lymphatic channels.
 Carcinoma of Lip
o Diagnosis
Clinical diagnosis: ulcerative growth with destruction of lip
is present.
Laboratory diagnosis: it is mainly well differentiated
malignancies.
o Management
Surgical: prognosis is good if the treatment is done before
metastasis.
The best results are seen when being obtained when the
entire lip mucosal field is removed for early lesion.