Lip And Oral Cavity Cancer Treatment

Lip And Oral Cavity Cancer Treatment

Write briefly on lesions of lips.

Answer. Following are the lesions of lips:

Developmental Lesions

• Congenital lip pits
• Commissural lip pits
• Double lip
• Cleft lip.

Inflammatory Lesions

• Glandular cheilitis
• Angular cheilitis
• Granulomatous cheilitis
• Contact cheilitis
• Actinic cheilitis
• Eczematous cheilitis
• Exfoliative cheilitis
• Plasma cell cheilitis
• Cheilitis due to drugs.

lip Carcinoma

Miscellaneous

• Actinic elastosis
• Lip ulcers.

Developmental Lesions Of Lip

Congenital lip Pits

• It is also known as congenital fitula.
• Pathogenesis: It occur due to failure of union of embryonic sulcus of lip which leads to persistent lateral sulci on embryonic mandibular arch.
• Features: It more commonly occurs in females; vermilion border of lip is commonly involved.
  Lower lip is involved; lesion is present in form of depression; on palpation, mucous secretion is seen from the base of lip pit.
• Treatment: Surgical excision is done.

Commissural lip Pits

• They are mucosal invagination which arises at vermilion border of lip.
• Pathogenesis: Its occurrence is due to failure of normal fusion of embryonic maxillary and mandibular processes.
• Features: Males are commonly affcted; it present as unilateral or bilateral pit at corners of mouth on vermilion border.
  Its size ranges from a shallow depression to an open tract measuring 4 mm; On palpation less amount of saliva ooze out.
• Treatment: Surgical excision is done.

Double Lip

• It is a fold of excessive tissue over inner mucosa of lip.
• Pathogenesis: It arises during second week of gestation because of persistence of sulcus between pars glabrosa and pars villosa of lip.
• Features: Inner aspect of lip is involved; at times when the upper lip become tensed, double lip give appearance of cupid bow.
• Treatment: Surgical excision is done

Cleft lip

• Cleft lip results from abnormal development ofthe median nasal and maxillary process.
• Pathogenesis: This is due to imperfect fusion of maxillary process with median nasal process which produce lateral cleft lip and due to failure of fusion of two median nasal processes which produce central cleft lip.
• Features: Patient has diffilty in sucking; defective speech is present, i.e. patient is unable to speak word such as B,F, M, P and V.
• Treatment: Millard’s criteria is use to undertake surgery for cleft lip, i.e. Rule of ten, i.e. 10 pound in weight; 10 weeks old; 10 g% hemoglobin; Millard cleft repair by rotating local nasolabial flps; proper postoperative management like control of infection, training for sucking, swallowing and speech.

Inflammatory Lesions of Lip

• Glandular cheilitis: Lower lip is mostly affected and the lip become enlarged, become fim and get everted. It mainly occurs due to sun exposure.
• Angular cheilitis: In it cracking of lips is seen from the corners. Main cause is nutritional deficiency.
• Actinic cheilitis: It is a pre-malignant lesion. Occurs due to sun exposure.
  Lower lip is mostly affcted. Lip become dry and scaly. If scales are removed bleeding points are seen.

Lip Carcinoma

Vermilion border oflip and mucosa is the main site ofcarcinoma of lip.
It is common in the western elderly, white people,especially those people exposed to sunlight.

Lip Carcinoma Clinical Features

• Elderly males are affcted in 90% of cases.
• Non-healing ulcer or growth is a common presentation.
• Lesion appears in the form of white plaque of non-healing ulcers.
• Edges are everted and indurated, this is characteristic of carcinoma.
• Ulcer contain slough in flor.
• Bleeding may occur from ulcer.
• Pain and paresthesia may occur.
• Lesion may get fied to the subcutaneous structure of lip.
• Ulcer spreads and destroys the tissue of lip and chin.
• Submental and submandibular lymph nodes are involved,lymph node becomes hard and maybe fied.

Lip Carcinoma Treatment

• If lesion is less than 2 cm, then curative radiotherapy, either brachytherapy or external beam radiotherapy. It gives a good cure.
• If tumor is more than 2 cm, wide excision is done. Excision of lower lip up to one-third can be sutured primarily,in layers keeping vermilion border in proper apposition without causing any microstomia.
• Excision of more than one-third of the lip requires reconstruction using different flaps.