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Median lip fissures and their management
Int. J. Oral Maxillqfac. Sw2~. 1997; 26." 299 300 PHnted in Denmark. All Hghts reserved
Copyright 9 Munksgaard 1997 IntemadonaUouma[ of
Oral & MaxillofacialSurgery ISSN 0901-5027
Median lip fissures and their management
N. Rashid, H. Yusuf Department of Oral and Maxillofacial Surgery, North East Lincolnshire NHS Trust, Grimsby, North East Lincolnshire, UK
N. Rashid, H. Yusuf" Median lip fissures and their management. Int. J. Oral Maxillofac. Surg. 1997," 26." 299 300. 9 Munksgaard, 1997 Abstract. Median lip fissures are an u n c o m m o n condition and usually give rise to pain and episodes of bleeding. We report three cases of median lip fissures which were treated by surgical excision.
Fissures are any clefts or grooves which may be present in the mucous membrane or the skin. They may be superficial or deep, linear, radiating, longitudinal, or transverse. Fissuring of the surface of the tongue, and angular cheilitis are also seen frequently, but it is not c o m m o n to see fissures of the lip. Median lip fissures are generally chronic in nature. The reported prevalence of the lesion is 0.25% and they
seem to cause soreness and episodes of spontaneous bleeding s. Chronic lip fissures occur in both upper and lower lips but are most c o m m o n in the lower lip and tend to be more common in men 3. Various treatment modalities involving local application of nitrates, topical steroid preparations, and antibacterial and antifungal ointments tend to treat the condition symptomatically rather than curing it. Cryotherapy and surgi-
Fig. 1. Fissure running along midline of lower lip.
Key words: median lip fissure. Accepted for publication 4 Febuary 1997
cal excision with or without Z-plasty have been used quite effectively. Case histories Case 1
A 26-year-old woman presented with a midline fissure in the lower lip, which had been present since birth with a history of frequent bleeding and pain. Examination revealed a fissure running along the midline of the lower lip approaching the vermilion border with
Fig. 2. Healed tissue following surgical excision.
300
Rashid and Yusuf
Fig. 3. Central furrow lined by hyperplastic epithelium with parakeratosis and chronic inflammatory cells (HE x 100).
crusty margins (Fig. 1). Following surgical excision, she has remained free of problems for three years (Fig. 2).
muscle. The wound was closed in layers using undyed 5-0 vicryl sutures.
Case 2
Discussion
A 62-year-old woman was referred because of a chronic fissure in the midline of the upper lip. Following surgical excision she has remained symptom-free for 12 months with no signs of recurrence.
While the prevalence of midline lip fissures is only 0.25%, it is n o t u n c o m m o n for these fissures to b e c o m e inflamed a n d the patients can then suffer from frequent episodes of soreness a n d bleeding. In the cases reported, no obvious etiological factor was n o t e d which m a y be connected to the fissures, n o r was there a family history of lip fissures. The exact cause of the lesion is unk n o w n t h o u g h various predisposing factors have been suggested, such as b r e a t h i n g t h r o u g h the m o u t h , o u t d o o r occupations, smoking, a n d bacterial and mycotic infections, b u t n o single cause has been established. ROSENQUIST5 suggests a hereditary predisposition for a weakness in the fusion between the prenatal lateral segments of the lower lip, which leads m o r e often to m e d i a n lip fissures in m e n t h a n in women. Lip fissures are also c o m m o n in D o w n ' s s y n d r o m e a n d C r o h n ' s disease 6, however, in n o n e of the cases r e p o r t e d here were there signs or s y m p t o m s of either condition. AXELL & SKOGLUND1 suggest surgical excision a n d have r e p o r t e d good results
Case 3 An 18-year-old man presented with a midline fissure in the lower lip, which had been present for several years and which bled occasionally. Following excision of the fissure, he has remained symptom-free for about four years. Histology The fissures were generally lined by hyperkeratinized and notably hyperplastic stratified squamous epithelium with a variable degree of chronically inflamed fibrous connective tissue (Fig. 3). One of the cases exhibited reactive epithelial atypia. Normal muscle tissue was found in all specimens. No evidence of candidal hyphae was noted. Surgical technique An incision was made around the fissure incorporating the whole length and including 2 3 mm of adjacent normal tissue. Dissection was extended up to the orbicularis oris
in seven patients. They also note t h a t conservative management provides p o o r results. BALL &; BARNARD 2 a r e unable to justify surgical excision o n the g r o u n d s t h a t lip fissures are of a m i n o r nature, a n d propose c r y o t h e r a p y for a simple a n d effective resolution. IANKOV4 puts forward the possibility o f p o t e n t i a l m a l i g n a n t change in chronic lip fissures. TOCHILOVSKAYA 7 also suggests the possibility of m a l i g n a n t t r a n s f o r m a t i o n in these lesions, i n one of o u r cases, cellular atypia was r e p o r t e d histologically, which was t h o u g h t to reflect a rea c t i o n to the n u m e r o u s topical medica m e n t s to which the patient h a d been subjected. We concur with the views of AX~LL & SKOGLUND 1 t h a t the best available t r e a t m e n t option for m e d i a n lip fissures is surgical excision.
References 1. AXELL T, SKOGLUND A. Chronic lip fissure. Int J Oral Maxillofac Surg 1981: 10: 354 8. 2. BALL G, BARNARD D. The treatment of chronic lip fissures with cryotherapy. Br Dent J 1984: 157:64 6. 3. FEIWEL M. Diseases of the lips. Practitioner 1976: 216: 159-66. 4. IANKOV N. Surgical treatment of chronic lip fissure of the lip. Stomatologiia (Mosk) 1978: 57: 85-6. 5. ROSENQUIST B. Median lip fissure: etiology and suggested treatment. Oral surg 1991: 72:10 4. 6. SCULLY C, FLINT SR, PORTER SR. Oral diseases, 2nd ed. Stockton, UK: Stockton Press, 1995: 211. 7. TOCHILOVSKAYARV. Cryotherapy of nonspecific erosive and ulcerative lesions of mucous membrane of mouth and lips. Stomato/ogiia (Mosk) 1981: 60: 24~6. Address: H. Yusuf MDS FDSRCPS Consultant, Oral and Maxillojacial Surgery North East Lincolnshire NHS Trust Grimsby Hospital Seartho Road Grimsby DN33 2BA UK
Copyright 9 Munksgaard 1997 IntemadonaUouma[ of
Oral & MaxillofacialSurgery ISSN 0901-5027
Median lip fissures and their management
N. Rashid, H. Yusuf Department of Oral and Maxillofacial Surgery, North East Lincolnshire NHS Trust, Grimsby, North East Lincolnshire, UK
N. Rashid, H. Yusuf" Median lip fissures and their management. Int. J. Oral Maxillofac. Surg. 1997," 26." 299 300. 9 Munksgaard, 1997 Abstract. Median lip fissures are an u n c o m m o n condition and usually give rise to pain and episodes of bleeding. We report three cases of median lip fissures which were treated by surgical excision.
Fissures are any clefts or grooves which may be present in the mucous membrane or the skin. They may be superficial or deep, linear, radiating, longitudinal, or transverse. Fissuring of the surface of the tongue, and angular cheilitis are also seen frequently, but it is not c o m m o n to see fissures of the lip. Median lip fissures are generally chronic in nature. The reported prevalence of the lesion is 0.25% and they
seem to cause soreness and episodes of spontaneous bleeding s. Chronic lip fissures occur in both upper and lower lips but are most c o m m o n in the lower lip and tend to be more common in men 3. Various treatment modalities involving local application of nitrates, topical steroid preparations, and antibacterial and antifungal ointments tend to treat the condition symptomatically rather than curing it. Cryotherapy and surgi-
Fig. 1. Fissure running along midline of lower lip.
Key words: median lip fissure. Accepted for publication 4 Febuary 1997
cal excision with or without Z-plasty have been used quite effectively. Case histories Case 1
A 26-year-old woman presented with a midline fissure in the lower lip, which had been present since birth with a history of frequent bleeding and pain. Examination revealed a fissure running along the midline of the lower lip approaching the vermilion border with
Fig. 2. Healed tissue following surgical excision.
300
Rashid and Yusuf
Fig. 3. Central furrow lined by hyperplastic epithelium with parakeratosis and chronic inflammatory cells (HE x 100).
crusty margins (Fig. 1). Following surgical excision, she has remained free of problems for three years (Fig. 2).
muscle. The wound was closed in layers using undyed 5-0 vicryl sutures.
Case 2
Discussion
A 62-year-old woman was referred because of a chronic fissure in the midline of the upper lip. Following surgical excision she has remained symptom-free for 12 months with no signs of recurrence.
While the prevalence of midline lip fissures is only 0.25%, it is n o t u n c o m m o n for these fissures to b e c o m e inflamed a n d the patients can then suffer from frequent episodes of soreness a n d bleeding. In the cases reported, no obvious etiological factor was n o t e d which m a y be connected to the fissures, n o r was there a family history of lip fissures. The exact cause of the lesion is unk n o w n t h o u g h various predisposing factors have been suggested, such as b r e a t h i n g t h r o u g h the m o u t h , o u t d o o r occupations, smoking, a n d bacterial and mycotic infections, b u t n o single cause has been established. ROSENQUIST5 suggests a hereditary predisposition for a weakness in the fusion between the prenatal lateral segments of the lower lip, which leads m o r e often to m e d i a n lip fissures in m e n t h a n in women. Lip fissures are also c o m m o n in D o w n ' s s y n d r o m e a n d C r o h n ' s disease 6, however, in n o n e of the cases r e p o r t e d here were there signs or s y m p t o m s of either condition. AXELL & SKOGLUND1 suggest surgical excision a n d have r e p o r t e d good results
Case 3 An 18-year-old man presented with a midline fissure in the lower lip, which had been present for several years and which bled occasionally. Following excision of the fissure, he has remained symptom-free for about four years. Histology The fissures were generally lined by hyperkeratinized and notably hyperplastic stratified squamous epithelium with a variable degree of chronically inflamed fibrous connective tissue (Fig. 3). One of the cases exhibited reactive epithelial atypia. Normal muscle tissue was found in all specimens. No evidence of candidal hyphae was noted. Surgical technique An incision was made around the fissure incorporating the whole length and including 2 3 mm of adjacent normal tissue. Dissection was extended up to the orbicularis oris
in seven patients. They also note t h a t conservative management provides p o o r results. BALL &; BARNARD 2 a r e unable to justify surgical excision o n the g r o u n d s t h a t lip fissures are of a m i n o r nature, a n d propose c r y o t h e r a p y for a simple a n d effective resolution. IANKOV4 puts forward the possibility o f p o t e n t i a l m a l i g n a n t change in chronic lip fissures. TOCHILOVSKAYA 7 also suggests the possibility of m a l i g n a n t t r a n s f o r m a t i o n in these lesions, i n one of o u r cases, cellular atypia was r e p o r t e d histologically, which was t h o u g h t to reflect a rea c t i o n to the n u m e r o u s topical medica m e n t s to which the patient h a d been subjected. We concur with the views of AX~LL & SKOGLUND 1 t h a t the best available t r e a t m e n t option for m e d i a n lip fissures is surgical excision.
References 1. AXELL T, SKOGLUND A. Chronic lip fissure. Int J Oral Maxillofac Surg 1981: 10: 354 8. 2. BALL G, BARNARD D. The treatment of chronic lip fissures with cryotherapy. Br Dent J 1984: 157:64 6. 3. FEIWEL M. Diseases of the lips. Practitioner 1976: 216: 159-66. 4. IANKOV N. Surgical treatment of chronic lip fissure of the lip. Stomatologiia (Mosk) 1978: 57: 85-6. 5. ROSENQUIST B. Median lip fissure: etiology and suggested treatment. Oral surg 1991: 72:10 4. 6. SCULLY C, FLINT SR, PORTER SR. Oral diseases, 2nd ed. Stockton, UK: Stockton Press, 1995: 211. 7. TOCHILOVSKAYARV. Cryotherapy of nonspecific erosive and ulcerative lesions of mucous membrane of mouth and lips. Stomato/ogiia (Mosk) 1981: 60: 24~6. Address: H. Yusuf MDS FDSRCPS Consultant, Oral and Maxillojacial Surgery North East Lincolnshire NHS Trust Grimsby Hospital Seartho Road Grimsby DN33 2BA UK