Q: Dr. Eppley, I have angular cheilitis and have had it for over 8 years since I was 14. I have tried numerous steroid and anti-fungal creams however it does not go away permanently. I was made aware some surgery can be done on the lips, to solve this problem. If there was something to be done, I’d like to know what it might be?
A: While topical medication is the primary treatment for angular cheilitis, some patients have an anatomic arrangement at the corners of their mouth that predisposes them to chronic salivary wetness. If the corners of the mouth are turned down significantly, there is a natural spillway for salivary spill or to allow chronic wetness to occur at the mucosa of the mouth corners. In these cases, it may be beneficial to consider a corner of the mouth lift to relieve this spillway effect. The lift removes the overhanging tissues and eliminates a downslanting mouth corner. In other cases without a significant corner downturn, the chronically inflamed or irritated mucosa just inside the mouth corners may be simply excised. This removes the chronically infect mucosa and brings in new healthy mucosa that is not inoculated.
Dr. Barry Eppley
Q: Dr. Eppley, I am only 56 years old but have a chronic infection of the skin below the corners of my mouth. I’ve been running for 36 years, so maybe that contributed to the sagging. More likely it’s a combination of things including the effects of menopause. The skin below the edges of my mouth is now chronically inflamed. Would surgery to correct this be considered medically necessary?
A: Sagging of the corners of the mouth can be a cause of angular cheilitis. Acting as a spillway for saliva, this can make the skin on the corners of the mouth chronically exposed to moisture resulting in a yeast-type skin infection. The first step would be to use a topical medication to treat the infection and then consider a corner of the mouth lift to change the skin’s exposure to salivation.
The sagging of the corners of the mouth is a simple function of aging and has nothing to do with running and menopause. It is the slow and inevitable of the lateral facial tissues falling forward against the fixed perioral tissues. Some people’s natural anatomy makes them more predisposed to deepening nasolabial folds and a skin overhang on the mouth corners driving them downward.
Dr. Barry Eppley
Q: I have drooling from the corners of my mouth and its embarrassing. I am 73 years old and have not had a stroke and I am still working everyday. What can be done for this corner of the mouth drooling problem. It was also occasionally get red and sore and painful. When this happens, it takes a fair while until it finally gets better. I have tried all sorts of antibiotic creams and salves but nothing seems to be that effective. I have read about a procedure called the corner of the mouth lift that removes the overhanging skin. Do you think this will help?
A: Downturning of the corners of the mouth, combined with aging which creates a skin overhang, creates a gutter effect at the corner of the mouth. This is the perfect setup for a runway for saliva. This problem can be further magnified with one has overclosure of their lower jaw due to a loss of teeth or ill-fitting dentures. This overclosure causes a lower lip inversion which makes the drool problem at the corner of the mouth worse. Localized infection at the mouth corners can happen due to the chronic wetness of skin that is not normally so like the lining inside the mouth. This is known as angular cheilitis. Topical steroids and antifungals can help but a change of the anatomy is more effective.
The corner of the mouth lift can be really helpful for this problem as it removes the skin overhang and lifts the mouth corner. This eliminates much of the spillway problem. There is a trade-off of a small scar that tails away from the mouth corner but this is not usually a significant cosmetic concern.
Dr. Barry Eppley
Q: I have been suffering from angular cheilitis subsequently leading to cutaneous candidiasis and sometimes even a secondary bacterial infection for the past 18 months. If my face starts to sweat I immediately dry off my face but am mortified when I awake to realize saliva has pooled in the little cracks in the corner of my mouth. Despite my best efforts, I cannot always keep this area dry.
My dentist told me that it was due to a parafunctional habit and anatomical variation. So I changed the one thing I could control and stopped licking my lips. However, since then my best efforts barely keep this at bay and last week I had a tiny pimple in that area, the skin broke open, and you know the rest, the lovely normal flora became and opportunistic pathogen eating my face away, looking unsightly, and cracking my skin open if I accidentally open my mouth too far.
People think I am crazy for wanting surgery and I fear the opinion of female family members due to the new age stigma of getting plastic surgery too young. This is not for vanity unless you count wanting to be kissed vain, and when I have this crap on my face even I do not want to kiss me! Or look at me for that matter, not to mention how painful and itchy this can be and how long it takes to heal!
I have read that there is a possible surgical treatment for angular cheilitis. What is it and do you think it will be helpful for me. I am just looking for a permanent solution to this nasty mouth problem.
A: Angular cheilitis, also called perleche, is an inflammatory mucositis at the corner of the mouth and usually affects both sides. It presents as deep cracks or splits which may bleed when the mouth is opened widely. Why it occurs is not known precisely. Chronic wetness at the corners is the incipient event and that is most understandable in the elderly edentulous population who experience a loss of vertical dimension due to loss of teeth, thus allowing for over-closure of the mouth. This creates a spillway for saliva and chromic wetness in the mouth corners. Yet I have seen it just as often in younger patient who have a normal angulation of the corner of the mouth.
For those patients that have exhausted all medical treatments for angular cheilitis, surgical treatment is possible. When the corners of the mouth are sufficiently downturned, I have found a corner of the mouth lift to be helpful to change angulation and eliminate that spillway effect. In younger patients with a normal horizontal angulation, a resection of the mouth corner mucosa with mucosal advancement can be done. Sometimes this can include skin as well. The theory here is that the tissues are chronically infected and it is removed. I have seen improvements of the condition with both approaches.
Dr. Barry Eppley