Cheilitis Glandularis Clinical Presentation
- Author: Ellen Eisenberg, DMD; Chief Editor: William D James, MD more...
Cheilitis glandularis is a chronic progressive condition. Patients typically present for diagnostic consultation within 3-12 months of onset. Complaints vary according to the nature and the degree of pain, the enlargement and the loss of elasticity of the lip, and the extent of evident surface change.
Asymptomatic lip swelling initially occurs with clear viscous secretion expressible from dilated ductal openings on the mucosal surface.
Some patients report periods of relative quiescence interrupted by transient or persistent painful episodes associated with suppurative discharge.
A burning discomfort or a sensation of rawness referable to the vermilion border may be reported. This is associated with atrophy, speckled leukoplakic change, erosion, or frank ulceration with crusting.
Cheilitis glandularis affects the lower lip almost exclusively, although it has been reported to affect the upper lip. It manifests as progressive, often multinodular enlargement, eversion, and induration.
Salivary gland duct orifices may be dilated and appear as red or black puncta.
Viscous clear secretions may initially exit the duct openings spontaneously.
In more suppurative cases, application of gentle pressure can elicit mucopurulent exudates.
With advancing lip prominence and mucosal eversion, the mucosal-vermilion junction is obfuscated.
Prolonged exposure to the external environment results in desiccation and disruption of the labial mucous membrane, predisposing it to inflammatory, infectious, and actinic influences.
Cheilitis glandularis had historically been subclassified into 3 types, now believed to represent evolving stages in severity of a single progressive disorder. In the simple type, multiple, painless, papular surface lesions with central depressions and dilated canals are seen. The superficial suppurative type (also referred to as Baelz disease) consists of painless, indurated swelling of the lip with shallow ulceration and crusting. Cheilitis glandularis of the deep suppurative type (cheilitis glandularis apostematosa, cheilitis glandularis suppurativa profunda, myxadenitis labialis) comprises a deep-seated infection with formation of abscesses, sinus tracts and fistulas, and potential for scarring.
The latter two types of cheilitis glandularis have the highest association with dysplasia and carcinoma, respectively.
Cheilitis glandularis is an unusual clinical manifestation of cheilitis that evolves in response to one or more diverse sources of chronic irritation.
Lip enlargement is attributable to inflammation, hyperemia, edema, and fibrosis.
Surface keratosis, erosion, and crusting develop consequent to longstanding actinic exposure or unusual repeated manipulations that include self-inflicted biting or other factitial trauma, excessive wetting from compulsive licking, drying (sometimes associated with mouth breathing, atopy, eczema, and asthma), and any other repeated stimulus that could serve as a chronic aggravating factor.
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