Cheilitis

Inflammation of the lips (cheilitis) and angles of the mouth (angular cheilitis or perlèche) (Fig. 656-1) are most commonly due to dryness, chapping, and lip licking. Excessive salivation and drooling, particularly in children with neurologic deficits, may also cause chronic irritation. Lesions of oral thrush may occasionally extend to the angles of the mouth. Protection can be provided by frequent applications of a bland ointment such as petrolatum. Candidosis should be treated with an appropriate antifungal agent, and contact dermatitis of the perioral skin should be treated with a low-potency topical corticosteroid ointment preparation and frequent use of petrolatum or a similar emollient.

Figure 656-1 Angular cheilitis.

Fordyce Spots

Fordyce spots are asymptomatic, minute, yellow-white papules on the vermilion border of the lips and buccal mucosa. These ectopic sebaceous glands may be found in otherwise normal individuals and require no therapy.

Mucocele

Mucus retention cysts are painless, fluctuant, tense, 2- to 10-mm, bluish papules on the lips (Fig. 656-2), tongue, palate, or buccal mucosa. Traumatic severance of the duct of a minor salivary gland leads to submucosal retention of mucus secretion. Those on the floor of the mouth are known as ranulas when the submaxillary or sublingual salivary ducts are involved. Fluctuations in size are usual, and the lesions may disappear temporarily after traumatic rupture. Recurrence is prevented by excision of the mucocele.

Figure 656-2 Mucocele on lower lip.

Aphthous Stomatitis (Canker Sores)

Aphthous stomatitis consists of solitary or multiple painful ulcerations occur on the labial (Fig. 656-3), buccal, or lingual mucosa and on the sublingual, palatal, or gingival mucosa (Chapter 307). Lesions may manifest initially as erythematous, indurated papules that erode rapidly to form sharply circumscribed, necrotic ulcers with a gray fibrinous exudate and an erythematous halo. Minor aphthous ulcers are 2-10 mm in diameter and heal spontaneously in 7-10 days. Major aphthous ulcers are >10 mm in diameter and take 10-30 days to heal. A third type of aphthous ulceration is herpetiform in appearance, manifesting as a few to numerous grouped 1- to 2-mm lesions that tend to coalesce into plaques that heal over 7-10 days. Approximately 30% of patients with recurrent lesions have a family history of the disorder (Chapter 307 for differential diagnosis).