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Cheilitis Glandularis (CG)

Definition

A rare, chronic inflammatory disorder of the lip—characterized by hypertrophy and inflammation of the minor salivary glands of the lip, leading to swelling, eversion, and mucopurulent discharge from duct openings.

Epidemiology
• Age: Most common in middle-aged to elderly adults
• Sex: Male predominance (ratio ~3:1)
• Site: Lower lip mostly
• Geography: More frequent in areas with high sun exposure

Etiology

Exact cause unknown, but associated with:
• Chronic irritation: Sun exposure, wind, smoking, mechanical trauma
• Poor lip hygiene
• Secondary infection (bacterial superinfection often with Staphylococcus aureus)
• Genetic predisposition (rarely reported familial cases)

Pathogenesis
• Chronic irritation → ductal ectasia of minor salivary glands → mucous retention + chronic infection → fibrosis & hypertrophy of lip tissue.
• Prolonged disease can predispose to actinic cheilitis and SCC.

Clinical Features
• Diffuse swelling and induration of lower lip
• Eversion of lip exposing mucosa
• Multiple small openings of ducts on lip surface—sometimes with mucopurulent discharge
• Tenderness (variable)
• Chronic course—progressive changes over years

Types (Kraus Classification)
1. Simple type – Mild swelling, dilated ducts, mucous discharge on pressure
2. Superficial suppurative type – Redness, crusting, purulent discharge, possible ulceration
3. Deep suppurative type – Chronic infection with abscesses, fistulas, sinus tracts

Differential Diagnosis
• Actinic cheilitis
• Angular cheilitis
• Mucoceles
• Chronic granulomatous cheilitis (e.g., Melkersson–Rosenthal syndrome)
• Early SCC of lip

Complications
• Malignant transformation to SCC (especially with long-standing inflammation + actinic damage)
• Cosmetic deformity of lip
• Chronic infection

Investigations
• Clinical diagnosis (based on appearance + history)
• Culture & sensitivity from discharge
• Biopsy: shows hyperplasia of minor salivary glands, ductal ectasia, chronic inflammatory infiltrate

Management

Conservative
• Lip hygiene, avoidance of sun/irritants
• Broad-spectrum antibiotics for acute infection
• Anti-inflammatory measures (topical corticosteroids in mild inflammation)

Surgical
• Vermilionectomy (lip shave) – treatment of choice for chronic/recurrent or dysplastic cases
• Wedge resection if focal involvement

Prognosis
• Good with early treatment
• Regular follow-up essential due to malignant potential

Key Points
• Think of CG in chronic lower lip swelling with duct openings & discharge.
• Always evaluate for actinic damage or early SCC.
• Vermilionectomy is both therapeutic and preventive.