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