Archive for January, 2006

Trauma. The lips, in plain sight and the center of much activity during life, usually have suffered bruising, biting, chafing and often a cut or two. Aside from scar formation and possible mild deformity which would result, trauma to the lips heals quickly and is seldom serious. Severe lacerations of the lips obviously requires surgical repair.

Cracked and Fissured Lips. Cracking of the lips, with deep fissure formation frequently results from exposure to sunlight and cold, and can be very painful and smile-preventing. It is seldom serious and heals quickly when protected with pomade or skin cream.

Cracking in the corners of the mouth in adult people often indicates ariboflavinosis, a vitamin B deficiency. When the cracking accompanies malnutrition or disease resulting from an inadequate diet, healing of the corners of the mouth usually responds readily to an adequate diet containing sufficient vitamin B.

Leukoplakia. A milky-colored coating, of a slightly thickened nature on the wet inner aspect of the lips, is the appearance of leukoplakia, considered to be a pre-cancerous condition. It can occur in other areas of the mouth, besides the lips, and is often associated with the use of tobacco in any of its forms. Leukoplakia conditions call for ceasing the use of tobacco and usually the removal of these lesions by surgery or cautery. Mouth cleanliness also becomes a matter of concern, and routine oral hygiene becomes imperative.

Examination of the Lips

The lips are examined also in a close-up mirror with the aid of a good light. If artificial dentures are used, they should be removed for better inspection of the lips’ inner surface.

1. Closely examine the lips externally and internally. Note any area of bluish discoloration or a whitish leathery formation especially on the inner aspect of the lips. These findings may represent birth mark discoloration or leukoplakia.

Fig. 23. The lips are the junction between the external skin and the internal lining of the body, called the mucosa. Because they are a sensitive region, the lips play a great role in routine living, as well as disease.

2. Note any definite cracking in the skin in the corners of the mouth where the lips join. Cracking here may have definite meaning in vitamin deficiency.

3. Look closely along the lip surface for any cracking, bleeding points, ulcer or long unhealed sores. They may represent fissure in the lips or cancer in this location.

4. Observe the contour and motion of the lip. Note any paralysis, drooling saliva, or weakness in the lip movement. Compress the lips, smile widely, bare the teeth, and pucker the lips as in whistling position.
Inability to perform these lip actions, may represent facial paralysis, a stroke or possibly complex nerve disease within the body.

Facial Deformity and Irregularity. No two sides of anybody’s face are exactly alike. The ears differ; the eyes differ; the sides of the face or the nose or the mouth are not equal and facial movements also differ on each side of the face. Characteristic facial expressions such as smiling are done more with one side of the face than another, and so are many other facial expressions. In our examination above, the mirror image of each side of the face is reproduced for observation. It becomes readily apparent that one side of the face is more handsome than the

Fig. 22. Trouble with ingrown hairs begins with the shaving process. The very short remaining hair grows into the overhanging skin to begin an infection. Most often it is seen in men whose beard hair grows on a slant.

other. Obscure history would have us believe that one side of the face represents a man’s soul, while the other side represents his will. Which side is which, must be determined by each individual.

Ingrown Hairs. As is well-known, most hair grows outwardly. At times however, there are hairs which grow underneath the skin rather than over it. The difficulty arises where shaving is a daily issue in beards with whiskers which do not stand up straight, but which grow sideways in one or more directions.

The treatment of ingrown hairs requires the elimination of each involved hair, with patient cleanliness to prevent infection. Prevention of ingrown hair is possible by changing shaving habits to eliminate the close shave. When it is learned that only the closely-shaven hair can become an ingrown hair, it also becomes obvious that the longer hairs cannot be troublesome. Some find electric razors of value in preventing ingrown hair, whereas, others have found that blade razors work best for them.

Tics, Unintended Facial Movements. Tics are unusual nervous twitches in the face, caused by spasms of local facial muscles. Some twitching can be stopped at will, but others are entirely uncontrollable. Tics are not serious when they represent temporary excessive nervousness, but when they become persistent, they may represent serious underlying disease. They most commonly involve the face about the eye, nose, and mouth.
Tic Douloureux is a well-known type of tic usually seen in the later years of life. It is very painful, strikes without warning and usually affects only one side. It produces a savage lancing pain in the temple, jaw, or teeth, and is sometimes brought about by the slight stimulation of shaving, exposure to cold or draught, and sometimes without any stimulation at all. The pain usually does not last long, it may recur with agonizing frequency.

Fig. 21. Tic Douloureux, facial neuralgia, trigeminal neuralgia are one and the same difficulty. Savage pain in one side of the face may begin with a mild trigger action, such as shaving, a cold breeze or light touch. Pain is caused by a nerve defect of the fifth (trigeminal) cranial nerve; cutting this nerve is sometimes necessary for relief. Attacks may stay away for years at a time.

Tic Douloureux involves a cranial nerve, which is the nerve of sensation to the entire face, teeth, nose, and eyes. The exact cause of this painful disease is unknown but medical and surgical measures, in the hands of the physician, are definitely available for adequate relief.

Facial Palsy. Paralysis of portions of the face is very common. Palsies of only one side of the face, frequently occur as a result of exposure to cold, or extreme emotional disturbances. They may accompany an impending or recent stroke, especially in the older age group and they may also be accompanied by paralysis of some other portion of the body.

Another type of facial palsy is called Ptosis of the eyelids and appears as an eyelid which opens only partially. Ptosis of the eyelid, especially when confined to one side, may be associated with more serious underlying disease. An example is Horner’s Syndrome, a most complex difficulty, involving not only the eyelid, but other complex body structures as well. Only a skilled physician can recognize and prescribe the necessary treatment for such difficulty.

Skin Cancer and Other Growths. The skin of the face is the site for most skin cancers. This is because the face is the body area most exposed to sunlight, wind, and weather of all sorts. A skin cancer may begin as a small pearly growth which is continually unhealed, possibly crusted or bleeding, and probably oozing most of the time. Other growths of the skin such as warts, blemishes, moles and blood-filled growths are very common on the face. (See Skin Diseases).

Face Growths. In the face, growths of large or small caliber, may appear beneath the skin. One of the common sites for these growths is on the side of the head, just in front of the ear. This is the region of the parotid salivary gland, which gives rise to

Fig. 20. Mumps-like enlargements of the parotid salivary gland occur below and in front of the ears in later life, possibly due to infection or tumor growth. Tumors of the parotid gland are slow-growing, painless and questionably cancerous; they can be dealt with surgically.

frequent enlargements. Often the enlargement is only temporary, such as an enlarged lymph node similar to those seen in the neck. Growths of the parotid or anywhere underneath the skin, however, may be of cancerous nature, and should be strongly suspected until proven otherwise by the physician.

The treatment of facial growths, of the parotid gland or other regions, is essentially a surgical operation, in which the removal of the growth is usually curative. However, in cases where facial enlargement is only one site of many enlargements all over the body, other treatment may be necessary, depending upon the physician’s judgment.