Cheilitis glandularis is a disease in which there is congenital or acquired hyperfunction, hyperplasia or heterotopia of the salivary glands at the border of the red border of the lips (Klein zone). A characteristic feature of this pathology is the expansion of the ducts of the salivary glands and constant salivation. Histomorphological examination is used to clarify the diagnosis. Treatment includes a complex of general and local drug therapy and, in some cases, surgical intervention. If cheilitis glandularis is a consequence of another lip disease, the first step is to eliminate the root cause.
Meaning
Cheilitis glandularis is a congenital or acquired change in the structure and function of the salivary glands in the Klein zone, accompanied by almost continuous salivation. The pathological process, as a rule, affects the glandular tissue of the lower lip, the salivary glands of the upper lip are affected less often. The disease is chronic and is usually diagnosed at the age of 50-60 years. In patients younger than 20 years of age, cheilitis glandularis is extremely rare. The risk of developing the disease in men is 2 times higher than in women. Pathology is more common in people with an unsatisfactory condition of the oral cavity, inflammatory diseases of the teeth and gums, smokers and neglecting dental treatment. Cheilitis glandularis does not belong to precancerous diseases, but it can provoke malignant degeneration of the lip epithelium.
Causes
In dentistry, there are two forms of pathology, each of which has its own causes. The primary form occurs as a result of congenital abnormalities of the salivary glands. As a rule, if parents suffer from this disease, there is a high probability that children will have a similar problem. However, clinical manifestations of the anomaly are diagnosed only after 20 years. Hypertrophy of the salivary glands is noted in the Klein zone, accompanied by increased salivation.
In the secondary form, which develops against the background of lip diseases such as leukoplakia, lichen planus and lupus erythematosus, due to constant irritation, glandular tissue hyperplasia and glandular hyperfunction develop. The presence of chronic inflammation of the lip skin, periodontal disease, periodontitis, and especially destroyed diseased teeth with sharp edges and incorrectly fixed prostheses increases the likelihood of developing a secondary form. Pathologically dilated ducts of the salivary glands can become the entrance gate for pyogenic infection, and then purulent cheilitis glandularis (Volkman’s cheilitis) occurs.
Symptoms
The disease has a characteristic clinical picture and begins with the appearance of bright red dots on the lip mucosa and the red border. They are the mouths of hypertrophied salivary glands. If you wet your lips, after a while, droplets of saliva appear again. Due to increased salivation, the surface of the lips is constantly moistened, but after evaporation, the skin, accustomed to moisture, flakes and cracks. Some patients complain of itchy lips. The epithelium of the affected area gradually becomes keratinized, the skin becomes rough. Foci of leukoplakia can form around the ducts of the salivary glands, which look like white ring-shaped formations when examined.
The most pronounced clinical picture is characteristic of purulent cheilitis glandularis. Patients complain of swelling of the lips and pain. On examination, puffiness and hyperemia of the lips are revealed, they are covered with purulent crusts. During palpatory examination, soreness of dense hypertrophied salivary glands is noted. If you press on an inflamed gland, saliva with an admixture of purulent exudate flows out of its duct. In severe cases, regional lymphadenitis, abscessing of the lips and general intoxication of the body are added. Cheilitis glandularis does not belong to precancerous diseases, but is a favorable soil for malignant degeneration of epithelial tissue.
Diagnostics
The disease has a characteristic clinical picture, but a biopsy of the salivary glands with further histological examination is necessary to verify the diagnosis. With cheilitis glandularis, hypertrophy of the salivary glands with a slight inflammatory infiltration around the ducts in the depth of the connective tissue layer is revealed. Epithelial tissue in some patients has no changes, while in others the phenomena of acanthosis and parakeratosis are noted. There is no granular layer, there are no changes in the spiny and basal layer.
Differential diagnosis is carried out with other types of cheilitis (actinic, exudative), which have other clinical and histological signs, as well as with infectious lesions of the lips in herpes simplex and secondary syphilis. To do this, blood test and smears from lesions are carried out in order to identify pathogens of infectious diseases. Folkman’s cheilitis must be distinguished from erysipelas and a furuncle of the lip.
Treatment
The disease requires a comprehensive approach to treatment: both local application of therapeutic and surgical methods and general therapy are necessary. For topical use, the following groups of drugs are prescribed: anti-inflammatory drugs (syntomycin emulsion, prednisolone ointment), enzymes (trypsin, chymotrypsin, lysozyme, ribonuclease, deoxyribonuclease), reparative drugs (dexanthenol, dental adhesive paste). It is necessary to monitor the condition of the oral cavity, carefully carry out hygiene procedures and abandon bad habits. Treatment of the underlying dental disease that provoked the development of cheilitis glandularis is mandatory.
To improve the patient’s somatic condition, sedatives and tranquilizers (valerian, phenazepam), vascular drugs (vinpocetine) and vitamin therapy are prescribed. With Folkman’s cheilitis, the use of broad-spectrum antibiotics is mandatory.
Electrocoagulation of the salivary glands is performed as a surgical treatment. For the procedure, a thin hair electrode is used, immersed to the full depth into the duct of the gland. If you affect the surface area of the excretory duct, treatment will be ineffective, and a retention cyst will develop. Patients with a large number of hypertrophied salivary glands are recommended to excise them. The operation is performed in the following sequence: the dentist-surgeon performs infiltration anesthesia, makes an incision along the Klein line, peels out the hypertrophied glands and applies catgut sutures.
Prognosis and prevention
With timely diagnosis and competent treatment, the prognosis is favorable. But in advanced cases, cheilitis glandularis can cause squamous cell lip cancer. Prevention of primary cheilitis is impossible, because a child is born with a predisposition to abnormal functioning of the salivary glands. To prevent secondary cheilitis, careful oral hygiene, timely treatment of dental diseases and smoking cessation are necessary.