Gerald S. Fine, D.D.S.

   Oral and Maxillofacial Surgery

Brookline Office
Tel: 617-731-6060

Our commitment is to provide you the highest standard of oral and maxillofacial surgery in a professional manner.

THE SWOLLEN LIP: Unexpected diagnosis

A few months ago I saw a patient with a swollen lip. What made this unusual was that this patient had been swollen for 4 months. His general dentist considered both local trauma and an allergic reaction as possible causes of the swelling, but after four months with no improvement, he referred his patient to our office. The patient's oral examination was unremarkable other than the lower lip was diffusely swollen. Swollen lips can result from local or systemic conditions, even serving as the first indication of a systemic disease. The broad categories of: trauma, infection, metabolic disease, neoplasm, and idiopathic conditions must all be considered.

The differential diagnosis included more than 180 conditions. To obtain a differential diagnosis more narrow in focus, pertinent questions raised included: (1) Was the onset acute or persistent? (2) Was the swelling localized or diffuse? (3) Had the area suffered trauma? (4) Was there a relevant medical history? (5) Was there either systemic or peri/oral indicators? By asking these questions I was able to narrow the possible causes of the swollen lip to T-cell lymphoma, sarcoidosis, and Crohn's disease.

A biopsy was performed which revealed granulomatous inflammation. The patient was referred to a gastroenterologist for assessment of either sarcoidosis or Crohn's disease and a colonoscopy revealed findings consistent with Crohn's disease.

Differential Diagnosis of Lip Swelling
 Trauma  Deep Mucocele, Lip Contusion
 Inflammation  Allergy: Hives, Angioedema, Contact or Allergic Cheilitis

Granulomatous Inflammation: Crohn's disease, Sarcoidosis

 Infection  Odontogenic infection, Mycobacterium tuberculosis
 Metabolic disease  Myxedema, Acromegaly
 Neoplasm  T-cell lymphoma, Minor salivary gland tumor, Hemangioma

  
Although the vast majority of patient's referred to our office with a swollen lip are diagnosed as being caused by a deep mucocele or angioedema, other causes must always be considered. When a patient presents with unusual symptoms, it is wise to perform a step-by-step evaluation. The result may require local treatment and/or referral to a medical specialist.

‍Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery‍