Angular cheilitis is a chronic inflammation of the corners of the mouth which makes them cracked and painful. This condition can last for days to months, often cycling between almost gone only to come back as severe as ever. It makes opening the mouth painful as that pulls on the inflamed corners. In many cases, this is caused by a fungal infection which can be resolved by a combination antifungal and steroid cream.
In some cases of angular cheilitis, however, there is an anatomic reason why the corners of the mouth are chronically inflamed or predisposed to chronic wetness and subsequent infection. This is best illustrated in those who wear full dentures where age and ill-fitting dentures can cause the mouth to over close resulting in small folds of skin forming in the corners of the mouth. This can also occur in those with teeth where aging (facial sagging) or their natural anatomy create the same situation with the upper lip edges turning down or falling over the corner of the mouth. This anatomical change disrupts the natural dam effect of the mouth corners. Now a natural spillway (crease or fold) is created which makes these folds chronically moist with saliva providing the ideal conditions for angular cheilitis to form.
In these patients with overhanging folds at the corners of the mouth that will not respond to any method of conservative therapy, a small plastic surgery procedure may be effective. The overhanging fold of skin can be removed and lifted through a corner of the mouth lift. By removing a small triangle of skin along the overhanging skin (or the actual hanging skin can be removed), the corner of the mouth is turned up and the downturned crease improved. Injectable fillers or fat grafts can also be placed at the same time to plump up the corner and the remaining downward crease. These changes should eliminate or decrease the salivary spillway so it occurs less or not at all. This simple procedure can be easily performed in the office under local anesthesia. I have done this a few times in refractory cases of angular cheilitis and it has worked well. One also gets the cosmetic benefit of getting rid of a downturned mouth or smile line.
The corner of the mouth lift is a procedure of last resort for angular cheilitis. It is not for every case and one’s anatomy has to be just right and proven to not respond well to topical treatments.
Dr. Barry Eppley
Indianapolis, Indiana