Swollen lips

Dr. Srishti GuptaMBBS

July 05, 2021

July 05, 2021

Swollen lips
Swollen lips

The human mouth is guarded by two fleshy paired structures called the lips. The lips are richly supplied by intricate networks of nerves and blood vessels, making them highly sensitive. The set of lips are composed of the upper lip and the lower lip, both of which lie over the teeth and gums of the upper and lower jaw when the mouth is closed. Although the shape of the lips may differ amongst different ethnic groups, the normal ratio between the sizes of the upper and lower lips is approximately between 1:1 and 1:1.6, which means that the lower lip is normally either the same size as the upper lip or slightly bigger. The upper lip has an additional property of having a gentle depression in the middle of its contour called the Cupid’s bow. The muscles of the face surrounding the lips control its movements, especially at the angles or corners of the mouth, and give human beings the distinct ability to express emotions. The skin over the lips is more delicate than skin over other parts of the face as it is composed of fewer cellular layers and is, therefore, more prone to injury. Additionally, the skin of the lips lacks sweat glands and hair follicles, making it prone to drying out and becoming “chapped” faster. 

(Read more: Home remedies for chapped lips)

Besides holding cosmetic significance to the facial anatomy of a person, lips also serve various important functions such as:

  • Opening and closing of the mouth orifice for food intake and other activities
  • Articulation of sounds while speaking: Speech can be significantly impacted without proper articulation with the lips and the tongue.
  • Tactile organ for the sensation of touch: The lips are richly supplied with nerve endings that allow them to perceive touch, temperature and pressure.
  • Erogenous zone: The rich supply of nerve endings also make the stimulation of the lips a source of derived pleasure.
  • Facial expressions: Important non-verbal cues like expressions are key to communication between people. For example, by smiling or pursing lips, one’s feelings can be expressed without words.

Owing to the delicate nature of lips, wide network of underlying blood vessels and thin overlying skin, it is easy for them to become swollen. The reasons for lip swelling can be due to inflammation, which produces redness, tenderness, warmth and edema. It can also be due to other diseases affecting the soft tissue of the lips. The swollen lips may either retain their shape and proportion and display an overall enlargement, or the shape of the lip contour may be lost and the regular proportions between the upper and the lower lip may be distorted. In some cases, the swelling of lips may be asymmetrical and either affect one lip more than the other or simply only affect one. Cheilitis is the medical term for inflammation of the lips. Various types of cheilitis can occur but only a few are predominantly marked by swollen lips.

Signs and symptoms of swollen lips

While associated signs and symptoms will differ based on the cause of swollen lips, most cases of lip swelling present similarly. Some clinical features of lip swelling include, but may not be limited to:

If the following features are also present, the patient is likely to be experiencing a severe anaphylaxis reaction and needs emergency medical care:

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Causes of swollen lips

The causes for swollen lips can be multifactorial, sometimes resulting from diseases specifically affecting the lips and at other times as a result of systemic diseases. Common causes of swollen lips include, but may not be limited to:

  • Trauma or injury to the lips and mouth: Hematomas, or collection of blood in soft tissues outside blood vessels, can form in the lips following an injury or contusion to them.
  • Sleeping in awkward positions: This can also injure the lips and cause them to swell overnight.
  • Infections: Different areas of infection can cause the lips to swell or appear swollen: 
    • Oral herpes or cold sores: Caused by herpes simplex virus type 1 (and sometimes by type 2), herpes is a disease that can not be cured. Oral blisters and swelling can appear at the time of physical or psychological stress as cold sores in patients who have been infected.
    • Cellulitis: Bacterial infection affecting the deeper layers of skin (dermis) and subcutaneous tissues can occur anywhere in the body, including in the lips. 
    • Cystic acne: Acne near the lips can cause the lips to appear swollen by extension. 
    • Gingivitis: Swelling and inflammation of the gums due to bacterial infections can cause the lips to appear swollen externally.
  • Dental braces: Constant irritation of the inner surface of the lips by dental braces can cause bruises or minor swelling, which usually resolves on its own.
  • Angioedema: Severe allergic reactions can cause vasoconstriction of blood vessels, causing them to narrow and the fluid within them to pool outside. Edema or fluid collection occurs throughout the body in such conditions but is more pronounced and noticeable in the eyes and the lips, as the skin in these areas is much thinner. Angioedema is a medical emergency and hospital care should be sought immediately.
  • Oral allergy syndrome: A cluster of changes in the skin and mucous membranes of the mouth and throat following ingestion of a food allergen like certain fresh fruits, nuts and vegetables. Oral allergy syndrome can be associated with burning, itching and swelling of the lips, mouth and pharynx. Vomiting, diarrhea and gastrointestinal problems are common. Skin hives and allergic anaphylaxis are also possible in severe cases. Interestingly, the foods a person is prone to develop oral allergy syndrome from after ingestion are typically the ones that are pollinated by the same type of pollen. For example, if a person suffers from oral allergy syndrome after eating bananas, which are pollinated by ragweed pollen, there is also a small chance of allergic reaction upon eating other fruits and vegetables pollinated by ragweed pollen, including watermelon, cantaloupe, honeydew, zucchini and cucumber.
  • Cheilitis: Inflammation of the lips is called cheilitis. Various different types of cheilitis can occur but a few are predominantly associated with lip swelling. A brief classification of different types of cheilitis is given below:
    • Cheilitis simplex: Dried chapped lips that occur commonly with dehydration and loss of moisture. 
    • Actinic cheilitis: Exposure to excessive sunlight can cause this.
    • Eczematous cheilitis: Atopic dermatitis or eczema affecting the skin of the lips can cause swollen lips. 
    • Infectious cheilitis: Lip infections are common with fungi like candida and bacteria like staphylococcus aureus and streptococcus pyogenes can cause lip swelling.
    • Cheilitis granulomatosa: Granulomas can form with certain types of inflammation that cause lumps to form in lips. Chronic lip swelling occurs with cheilitis granulomatosis associated with Melkersson Rosenthal Syndrome. 
    • Cheilitis glandularis: It is an inflammatory condition affecting the minor salivary glands. The lips, predominantly the lower lip, become swollen and everted. Mucopurulent discharge can be associated with it. It usually occurs due to poor hygiene in middle-aged men.
  • Drug-related side effects: The lips can become swollen as an adverse reaction to certain medicines. Some medicines that can cause swollen lips include isotretinoin and other retinoids used for skin conditions. Penicillin allergies in susceptible individuals can also cause swollen lips.
  • Excessive use of dermal lip fillers: Cosmetic beauty treatments by aesthetic doctors to enhance the fullness and shape of the lips is a common practice nowadays. However, sometimes, overzealous filling of dermal filler upon patient request can cause distortion of the lip proportion, shape and size.
  • Melkersson Rosenthal Syndrome: A very rare neurological disorder that causes recurrent paralysis of facial muscles, swelling of the face and lips, and furrows and folds to form in the tongue. The lip swelling is confined to the upper lip and is known as Cheilitis granulomatosis. While at first upper lip swelling occurs episodically, it can later persist and become permanent.
  • Lip carcinoma: Another rare cause of lip swelling is oral carcinoma of the lips. Tobacco chewing, smoking cigarettes, drinking alcohol and excessive exposure to the sun are risk factors for developing lip cancer and other types of oral cancers.

Diagnosis of swollen lips

The doctor will begin by taking a thorough medical history from the patient, laying special focus on preexisting health conditions and any long-term or short-term medications being taken. A note will also be made about the onset of the lip swelling noticed by the patient. Following this, a comprehensive clinical examination of the patient will be conducted. Systemic examination of the nervous system is important to potentially uncover any underlying neurological causes for the appearance of swollen lips. Oral examination with tongue depressors, speculums and some specialised mirrors is also warranted. In some cases, a reference may be made to a dentist for a dental examination if required. After examining the patient, some laboratory investigations may be requested; however, swollen lips largely remain a clinical diagnosis.

Tests for swollen lips

Some investigations may be sought if malignancy is suspected.

  • Biopsy: A small part of the suspicious tissue from the lip swelling will be removed by the doctor. A pathologist will assess it under a microscope to diagnose cancer.
  • Radiological imaging: CT scan can help stage the cancer if present and detect its spread in the body. A PET scan can also be used to pick up metastasis.
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Management of swollen lips

The treatment of swollen lips will be guided by the underlying disease or disorder that caused it. Some common principles for managing swelling of the lips are:

  • Conservative management: Ice packs can help reduce the swelling of lips, especially in instances following trauma or injury.
  • Medical management:
    • NSAIDs or over the counter painkillers can help reduce inflammation, pain and swelling of the lips.
    • Corticosteroids may be helpful in reducing lip swelling due to inflammatory diseases as well.
    • Antihistamines and anti-allergic medicines: Conditions like food pollen allergy or other allergic causes of swollen lips respond well to antihistamine medicines.
    • Dissolving lip dermal fillers with hyaluronidase injections: Hyaluronic-acid-based fillers are the ones that are most commonly used today for facial enhancements by doctors. If these fillers do not produce the desired cosmetic outcome, the patient may request to dissolve these fillers. Hyaluronidase is injected by the specialist into the lips and it slowly dissolves the hyaluronic acid filler.
  • Surgical management: Surgery is not needed in most cases of swollen lips unless a malignant or premalignant condition is diagnosed.
    • A biopsy followed by surgical removal of part of the lip and surrounding tissue margin in case of diagnosed lip cancer. Radiation therapy is used after surgical resection of lip cancer.
    • Verimillectomy: Cheilitis glandularis is a premalignant condition in which part of the lip may need to be shaved to prevent conversion to cancer.

Complications of swollen lips

Untreated or undiagnosed swollen lips can have potentially serious complications like:

  • Lip cancer: Some conditions that cause lip swelling are known to be precursors for cancer. In some cases, prophylactic treatment is necessary to prevent cancer from occurring.
  • Anaphylaxis: Severe allergic reactions can occur due to unrecognised allergies.
  • Respiratory arrest: If angioedema is not recognised and managed on time, the patient's airways may collapse and this may even prove to be fatal.
  • Sepsis: Bacteria can travel from gum and lip infection into the bloodstream and cause sepsis and septic shock.
  • Endocarditis: Bacterial gingivitis is associated with bacterial endocarditis by transmigration of bacteria.
  • Permanent lip swelling or disfigurement.

Prevention of swollen lips

Although all causes of lip swelling are not avoidable, some of the following precautions can be taken:

  • Avoid chewing tobacco
  • Avoid smoking cigarettes
  • Avoid alcohol consumption
  • Stay protected and use appropriate SPF-based sunscreens while out in the sun
  • Reduce sun overexposure
  • Avoid tanning practices
  • Maintain good oral hygiene
  • Practice safe sex to prevent herpes infections
  • Recognise allergies and prevent exposure to known allergens
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