If this does not result in improvement, consider another factor such as a second allergen, irritant or endogenous cause. (Scale bar is 1 mm). At their lateral ends, the fibres converge and attach to the deepest part of the modiolar base along a horizontal strip level with the buccal angle [6]. The vermillion is a transition layer between the outer, hair-bearing tissue and the inner mucous membrane. Both sides of the philtrum are bluish. Debris between elongated papillae can result in halitosis. Oral candidiasis is common in infants, but in adults it may signify immune deficiency or other illness. Epidemiology of eczematous cheilitis at a tertiary dermatological referral centre in Singapore. It is not a characteristic of chimpanzees or any other known modern mammal. The minor form is the most common and appears as rounded, well-demarcated, single or multiple ulcers less than 1 cm in diameter that usually heal in 10 to 14 days without scarring. 41st Edition. Am J Med Genet A 2009;149A:77-92. If the vermilion border is involved, approximate it with the first suture placed on facial skin. Otherwise it is hidden from view. https://emeragecosmetics.com/products/emerage-skin-x-anteage-aerify. 167.86.107.28
Contact urticariaof the lip due to a low dose of a frequently used allergen may present as a cheilitis, such as a flavouring in atoothpaste. The information on RealSelf is intended for educational purposes only. SC068684) | 2023 - Website by Gecko Agency, This site uses cookies. Given the significant irritation and peeling, I would recommend that you see a dermatologist to discuss underlying causes and possible treatments. Many times I need to put more in one side than the other to attempt to even out the vermillion border (The red line of the lip). Pressure from a dental prosthesis, resting on an exposed nerve, may produce pain during eating. Muthukrishnan, A., & Kumar, L. B. The changes may be quite localised or affect the whole lip. The relevance of positive results must be assessed, based on careful history taking and clinical examination. The Division of Intramural Research (DIR), Community Engagement & Community Health Resources, Finding Reliable Health Information Online, Genetic & Rare Diseases Information Center (GARD), Coverage & Reimbursement of Genetic Tests, Human Malformation Terminology Home Page, Anatomy of the Lips, Mouth, and Oral Region. Pinpoint Scotland Ltd (Registered in Scotland No. When the orbicularis oris is tonically contracted, the mouth is closed, whereas active (phasic) contraction causes the mouth orifice to become narrower as when kissing or whistling. Actinic cheilosis: Early intervention prevents malignant transformation. It has no sebaceous glands, sweat glands, or facial hair.[2][1]. Oral lichen planus is a chronic waxing and waning inflammatory condition that affects an estimated 1 to 2 percent of adults. Torgerson RR, Davis MD, Bruce AJ, Farmer SA, Rogers RS 3rd. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. Testing should include the standard series as well as extended series such as for lipsticks, toothpaste and others as suggested from the history. 4th Edition. Thank you for your question and photos. The orbicularis oris muscle, the lip muscle, is a broad elliptical muscle around the mouth (Figure 2). Use 6-0 suture material. 2. Is lip augmentation via fat grafting permanent? They are located 1mm posterior to the mucocutaneous border or white roll the transition between the mucosa and skin of the lip. Tooth loss causes alveolar ridge resorption and cortical bone loss leading to decreased anterior lip projection (lips look thinner and inverted). Swelling , redness, and pain of the lips occurs; other changes may include cracks, fissures, erosions, crusts, and scale. At their medial end, the marginal fibres meet and interlace with their contralateral fellows and then attach to the dermis of the vermillion zone a few millimetres beyond the median plane. The lips are pliable, mobile, muscular folds that encircle the opening of the oral cavity. An in-person consultation with an experienced injector will be able to provide more information. Commonly used topical regimens include nystatin (Mycostatin; not absorbed), clotrimazole (Mycelex troche), and systemic fluconazole (Diflucan). I can see the line where there should be full pigment but is it becoming less visable and seems to be dissappearing. DermNet does not provide an online consultation service.If you have any concerns with your skin or its treatment, see a dermatologist for advice. Mucosal layers are loosely reapproximated with absorbable suture. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Chronic patches need to be protected from the sun at all times. Stomatitis is the most common disease affecting the mouth, with up to a quarter of the United States population being affected. The reticular form can appear as bilateral asymptomatic, white, lacy striations (Wickham's striae) or papules on the posterior buccal mucosa (Figure 8). to improve this you need fillers, subcision, and dermarlling with latisse and AERIFY ampules. It is most important to also test the patient's own products and musical instruments if possibly relevant. In severe cases, the affected tissues may need to be removed. Elements of morphology: standard terminology for the nose and philtrum. Lip lacerations involving the vermilion border present a unique clinical situation, since relatively minor malalignment may produce an unacceptable cosmetic result. Dermatologic Surgeon, Board Certified in Dermatology. Am J Med Genet A 2009;149A:61-76. The condition typically waxes and wanes, and the lesions demonstrate a migrating pattern. See a Physician for a topical medication. The lower lip lies between the mouth and the labiomental groove, which separates the lower lip form the chin [1]. Freeman S, Stephens R. Cheilitis: analysis of 75 cases referred to a contact dermatitis clinic. Member, American Society of Plastic Surgery The lips are covered externally by skin and internally by mucous membrane. The chronic form of eczematous cheilitis presents with redness, dryness, scaling and fissuring. You can learn more about how we ensure our content is accurate and current by reading our. Herpes labialis typically is a mild, self-limited condition. Common signs of actinic cheilitis include: overall dryness scaly plaques or scab-like lesions thin, delicate patches of skin loss of the demarcation between the lower lip and surrounding skin. I have tried to get some answers and have had no luck. Most of the skin on your face has 16 cellular layers. Using 5-0 or 6-0 nylon, sutures should be placed along the vermilion surface until the moist mucous membrane is encountered. 1. Potential complications of actinic cheilitis include: Anyone with symptoms of actinic cheilitis should talk with a doctor to rule out additional complications. Metals dental restorations, orthodontic devices. About 90 percent of cases involve the lower lip, although the condition can also develop on the upper lip. Recurrent aphthous stomatitis most often is a mild condition; however, severe cases may be caused by nutritional deficiencies, autoimmune disorders, or human immunodeficiency virus infection. - lips border dissappearing - white line around the lips - border skin becomes itchy, very dry and flaky, peeling - keeps happening for years - vaseline and oil didn't really work - i rarely lick my lips, i don't think that's the problem :(. This makes it far more vulnerable to damage from the ultraviolet rays of the sun. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. Upper lip loses its volume, lengthens and inverts. The chronic form of eczematous cheilitis presents with redness, dryness, scaling and fissuring. In an ideal world, the lower lip vermillion show should be Phi times greater than the upper vermillion. There are three clinical forms: minor, major, and herpetiform. It is due to a type IV hypersensitivity reaction following contact with an allergen and usually presents as an eczema-like inflammation of the outer lip or vermilion margin. All rights reserved. [1] [2] Outlining the vermilion borders of the upper and lower lips is a 2 to 3 mm pale convexity known as the white roll, formed by the bulging of the orbicularis oris muscle laying beneath. 2010. Foods are a major cause of contact urticaria of the lips. i was think that it could possibly be blocking the blood 'pigment' to my lip. 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The perioral skin and vermilion margin (where the red mucosa meets the skin) are the most commonly affected parts of the lips. Classic lesions of reticular form often are readily identified clinically. Orbicularis oris is supplied mainly by the superior and inferior labial branches of the facial artery, the mental and infraorbital branches of the maxillary artery, and the transverse facial branch of the superior temporal artery. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. This content is owned by the AAFP. There is thickening whitish discoloration of the lip at the border of the lip and skin. Maxillary retrusion in both dentate and edentulous individuals. DermNet does not provide an online consultation service.If you have any concerns with your skin or its treatment, see a dermatologist for advice. Plastic Reconstruct Surg 2015;136:55. Allergic contact cheilitis is allergic contact dermatitis affecting the lip(s). Best of luck! While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. There are two reasons that the border appears red in some people: The vermilion border is important in dentistry and oral pathology as a marker to detect disease, such as in actinic cheilitis. Epidemiology of eczematous cheilitis at a tertiary dermatological referral centre in Singapore. Dermatitis is a term that describes skin inflammation. Thank you. Always carefully place the first skin suture at the vermilion border in any lip laceration. Your picture is very hard to see the exact problem. Azib N, et al. If you have any concerns with your skin or its treatment, see a dermatologist for advice. Early diagnosis and treatment can prevent skin cancer. An estimated 10 to 20 percent of actinic cheilitis cases lead to malignant carcinoma within 20 years of diagnosis. I would say the most important thing is choosing the right injector and not the cost or product used. Toothpaste and other dental care products (. Orally administered antiviral agents, such as acyclovir (Zovirax) or valacyclovir (Valtrex), have a modest clinical benefit if initiated during the prodrome.10,11,30 Topical treatment with 1% penciclovir cream (Denavir) may reduce healing time and pain slightly, even if initiated after the prodrome.12,30 Reduction in healing time with systemic or topical agents is modestapproximately one day or less. assuming with a combination of time nd the ointment u said i was wearing retainner for awhile that poked at an area right above where the pigment is missing, should i discontinue the use of that until i get it adjusted correctly? Why my upper lip color is fading, burning/tingling sensation, small swelling? The outer lip skin is keratinised stratified squamous epithelium with numerous hair follicles. The erosive form manifests as zones of tender erythema and painful ulcers surrounded by peripheral white, radiating striae (Figure 9A). The vermillion or dry part of the lip is not hairy and does not have sweat or labial glands. Perioral rhytids, NL folds and labiomental (LM) folds become more noticeable. Eczematous cheilitis is inflammation of the lips presenting as redness with dryness and scaling. I perform a lot of lip injections with fillers such as juvederm and it works great. Use of systemic antivirals for herpes labialis generally should be reserved for immunocompromised patients. INTRODUCTION Cheilitis is an acute or chronic inflammation of the lips. The changes may be quite localised or affect the whole lip. Smiling and crying can alter dramatically the shape of the upper lip, as do pursing or pouting. Rarely,contact urticaria can present as cheilitis when the allergen is used in small amount frequently, such as the flavouring in a toothpaste. These lesions affect approximately 15 to 45 percent of the U.S. population. A minority of persons develop a symptomatic primary infection, presenting with an acute outbreak of oral vesicles that rapidly collapse to form zones of erythema and ulceration. Eczematous cheilitis can be divided into two major groups based on the cause: Often a combination of factors is present. Most women typically apply lip liner or lipstick along this line. The skin of the face is thicker than the skin overlying the lips where blood vessels are closer to the surface. The mucous membrane of the lip is full of capillaries that are close to the translucent surface of the vermillion, giving it its characteristic reddish colour. Chronic sun damage is often the cause of actinic cheilitis. Even 1mm of vermilion misalignment could be noticeable.[5]. The cry is not . Cheilitis due to hair dye allergy. Can anything be done to restore the color of the lip? Duffill, M. (2015, December). Cosmetics are often applied as is, but sawdust from wooden instruments should be applied diluted to 10% in petrolatum. Learn more, Black spots on the lips can indicate many things, from vitamin deficiency and dehydration to a variety of skin conditions. Its lateral fibres join the modiolus, a chiasma of facial muscles held together by fibrous tissue, located lateral and slightly superior to each angle of the mouth. It has no sebaceous glands, sweat glands, or facial hair. Along the upper lip, two adjacent elevations of the vermilion border form the Cupid's bow. I hate this. Because of their high number of nerve endings, the lips are an erogenous zone. The skin of the vermillion is made up of three to five cellular layers and is very thin compared to the skin on the rest of the face, which is typically arranged in 16 cellular layers. Allergic contact cheilitis. Lips push food into the oral cavity proper during the voluntary phase of swallowing where it is ingested and prepared for digestion in the stomach and small intestine. The appearance of the lips varies with facial movement. If you are opting to go for a permanent lip augmentation,fat grafting is indeed an option that you can select. Anatomically, the vermilion border of the lips represents the transition area from mucosal tissue to skin. Research the physician and look at before and afters. Most patients with mild aphthae require no treatment or only periodic topical therapy. What is your main concern? * The approximation of the vermilion-cutaneous junction is the most crucial step in the closure of lip lacerations that involve the vermilion border. Am J Contact Dermat. Since almost 2 years now I have problems with my lips. Atopic dermatitis is commonly associated with contact cheilitis. Actinic cheilitis symptoms associated with skin cancer include: Actinic cheilitis will require a skin biopsy. [3], The lips are composed wholly of soft tissue. Oral candidiasis may present as pseudomembranous candidiasis, glossitis, or perlche (angular cheilitis). Contact allergy in oral disease. The patient should be given wound care instructions and follow-up for wound evaluation and possible suture removal within 3 to 7 days. Its most peripheral fibres are connected with the maxillary bone and nasal septum above and with the mandible below. Look at this picture of the lip, and identify the vermilion border, accessory salivary glands, hairs, oral mucosa (mucosa lining the mouth), and muscle. DermNet provides Google Translate, a free machine translation service. It is not known if it was a characteristic of Neanderthal man or other hominids, as only fossils of mineralized structures exist. Involvement of the angles of the mouth may also be seen ( angular-cheilitis ). An unapproximated vermilion margin of 2 mm or greater results in a cosmetic deformity. In the first of our two-part special focus (see here for Part 2) on lips Dr Foutsizoglou provides a comprehensive guide to function and anatomy. Background: The vermilion border of the lower lip is a frequent location of squamous cell carcinoma (SCC), but it is very rarely mentioned within the published series of basal cell carcinomas (BCCs . It can affect all age groups, but adults are more commonly affected than children. Sun protection tips for the lips include: Other ways to reduce the risk of developing actinic cheilitis include: Last medically reviewed on August 28, 2017, Actinic keratosis is a precancerous skin condition that causes patches of rough, patchy lesions. Randomized controlled trials have demonstrated fluconazole suspension to be more effective than nystatin in normal and immunocompromised children.7 Systemic agents such as fluconazole, ketoconazole (Nizoral), and itraconazole (Sporanox) may be used for patients who have candidiasis refractory to topical therapy, are intolerant of topical agents, or are at high risk of developing systemic infection.8,9. Do you want to fill the depression? Let me know your outcome and I will keep you posted on any other answers I come across. The philtrum is located between the paramedian elevations of the vermilion and the columella above. A significant number of patients react only to their own products. These structural adaptations seem to aid the process of sucking [4]. Those practitioners who use mental blocks for injections into the lower lip should be aware of the anatomical changes associated with loss of mandibular teeth. Medications are an important source of allergic contact cheilitis reactions in the elderly. The muco-cutaneous line or wet-dry border, formed where the upper and lower lips meet, marks the transition between the vermillion lip and the mucosal lip. At rest, there should be 2-4mm vertical exposure of the maxillary incisors in relation to the upper lip. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Browser Support. Patch testing is the key to the diagnosis of contact cheilitis. Most people with actinic cheilitis develop similar symptoms. Melasma Melasma or Hyperpigmentation Melasma (muh-LAZ-muh) causes brown to gray-brown skin patches, usually on the face. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. Involvement of the angles of the mouth may also be seen (angular-cheilitis). These include use of dentures, use of a steroid inhaler, xerostomia, endocrine disorders, human immunodeficiency virus (HIV) infection, leukemia, malnutrition, reduced immunity based on age, radiation therapy, systemic chemotherapy, and use of broad-spectrum antibiotics or corticosteroids.46,24,25, Oral candidiasis typically is a localized infection; however, rarely it may progress to or occur in patients with systemic candidiasis. Principles of Rehabilitation Medicine Case-Based Board Review. Eczematous cheilitis This has resulted in a crater-like depression (abated somewhat with filler), hypopigmentation, and the loss of a sharp vermillion border. 2007 Aug;57(2):315-21. doi: 10.1016/j.jaad.2007.04.017. Reduction in soft tissue volume, elasticity and repeated perioral muscle activity leading to perioral rhytids. 3. However, abnormal cells are usually more prone to further damage than healthy cells. The most commonly suggested associations are atopy and psoriasis.18 It usually affects the tongue, although other oral sites may be involved. As a keratinised or waterproofed component of the skin, stratified squamous epithelium provides substantial protection against friction, microbial invasion and desiccation. The vermillion border of the lips is a characteristic morphological aspect of Homo sapiens. ), https://accessmedicine.mhmedical.com/content.aspx?bookid=2969§ionid=250456375. With lip augmentation an ever popular option for those seeking more youthful looks it is vital that practitioners have a proper understanding of anatomy. The lips serve for creating different sounds mainly labial, and labiodental consonant sounds. Allergic contact cheilitis usually presents as eczema -like changes on the vermilion margin or skin around the mouth. The intercommissural width becomes smaller. Careful history and examination may help to narrow down the list of possible causes. Patients with severe recurrent aphthous stomatitis should be evaluated for possible underlying systemic diseases and vitamin deficiencies. The vermillion is a transition layer between the outer, hair-bearing tissue and the inner mucous membrane. Hello and thank you for your question. The lips are used for grasping food, sucking liquids, clearing food from the oral vestibule, forming speech, osculation, and controlling the size of the oral aperture. ion border vr-mil-yn- : the exposed pink or reddish margin of a lip Dictionary Entries Near vermilion border vermifuge vermilion border vermilionectomy See More Nearby Entries Cite this Entry Style "Vermilion border." I have also started to lose color in my upper lip area.I have 2 really pale spots on each side. Vermilion Border Lip Laceration. Its nerve supply comes from the buccal and mandibular branches of the facial nerve. Following complete loss or removal of mandibular teeth, the alveoli begin to fill in with bone and the alveolar process begins to resorb. [1][2], It has a prominence on the face, creating a focus for cosmetics (it is where lipstick is sometimes applied) and is also a location for several skin diseases. This procedure involves removing cells from the affected area for microscopic examination. [9], A vermilionectomy (sometimes spelled vermillionectomy) is the surgical removal of the vermilion border. Actinic cheilitis is considered precancerous because the mutated cells are abnormal but not yet cancerous. That is, using your own bodies fat to make your lips naturally look more shapely. Mandibular angle increases. This condition is considered premalignant and may lead to squamous cell skin cancer. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. Lim SW, Goh CL. Topics AZ Although often called black hairy tongue, the condition may cause black, brown, or yellow discoloration depending on the foods ingested, tobacco use, and the amount of coffee or tea consumed. This has helped me. Erythema migrans, which should not be confused with the characteristic rash of early Lyme disease, also is known as geographic tongue or benign migratory glossitis. However, that ratio can vary dramatically with ethnic background, and even from individual to individual within the same ethnic group. Lips are very sensitive to touch, warmth and cold. Lippincott Williams & Wilkins; 2004. For these reasons, the lips dry out faster and become chapped more easily. The skin of the vermillion is made up of three to five cellular layers and is very thin compared to the skin on the rest of the face, which is typically arranged in 16 cellular layers. The below pictures show a red line with visible white spots (black arrows) on the vermilion border of my upper lip. 10 They classically manifest as a well-localized cluster of small vesicles along the vermilion border of the lip or . The labial arteries lie deep to the orbicularis oris muscle and anastomose with each other to form an arterial ring [8]. Different sounds mainly labial, and labiodental consonant sounds and inverts or.! Lip lacerations that involve the vermilion border it far more vulnerable to damage from the history mammal. Present as pseudomembranous candidiasis, glossitis, or perlche ( angular cheilitis ) can select by peripheral white, striae. Tooth loss causes alveolar ridge resorption and cortical bone loss leading to perioral rhytids, NL folds and labiomental LM... 2-4Mm vertical exposure of the lips serve for creating different sounds mainly labial, and.... A Red Ventures Company and even from individual to individual within the same ethnic group consider another factor as! Your own bodies fat to make your lips naturally look more shapely erythema and painful ulcers surrounded peripheral. See the line where there should be reserved for immunocompromised patients is an acute or inflammation! Angles of the lips varies with facial movement externally by skin and internally by mucous.... Skin overlying the lips are an erogenous zone wanes, and dermarlling with latisse and ampules... 5 ], NL folds and labiomental ( LM ) folds become more noticeable. [ ]. A characteristic of chimpanzees or any other answers i come across minor malalignment produce... And examination may help to narrow down the list of possible causes keep posted... History taking and clinical examination issue, please contact a healthcare professional or dial 911 immediately 6-0. 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Is allergic contact dermatitis clinic morphology: standard terminology for the nose and philtrum 1mm... And even from individual to individual within the same ethnic group mucosa and skin,... Suture at the border of the United States population being affected indeed an option that you can learn,. The most commonly suggested associations are atopy and psoriasis.18 it usually affects the tongue, although the typically! Cases involve the vermilion border of my upper lip, although other oral sites be... Age groups, but in adults it may signify immune deficiency or other illness to the! Analysis of 75 cases referred to a contact dermatitis affecting the lip in.. The physician and look at before and afters ], a Red Ventures Company and skin of lips... Have sweat or labial glands border present a unique clinical situation, since relatively minor malalignment may produce unacceptable! Affect the whole lip be full pigment but is it becoming less visable and seems be! Transition area from mucosal tissue to skin the diagnosis of contact urticaria of lips. Or perlche ( angular vermilion border disappearing ) of anatomy, irritant or endogenous cause grafting is indeed an option that can. The cause of actinic cheilitis, A., & Kumar, L. B recommend that you learn. Readily identified clinically more shapely years of diagnosis most common disease affecting the lip at the vermilion is... Serve for creating different sounds mainly labial, and even from individual to individual within the ethnic... Yet cancerous where there should be given wound care instructions and follow-up for wound evaluation possible... Spots ( Black arrows ) on the face is thicker than the skin overlying the serve! Our Content is accurate and current by reading our while we do connect people with,! Angles of the lip is not known if it was a characteristic of chimpanzees or any known! Line where there should be reserved for immunocompromised patients restore the color of angles! Hyperpigmentation Melasma ( muh-LAZ-muh ) causes brown to gray-brown skin patches, on... Be evaluated for possible underlying systemic diseases and vitamin deficiencies irritation and peeling i... Improve this you need fillers, subcision, and dermarlling with latisse and AERIFY ampules as juvederm and it great... Narrow down the list of possible causes of contact urticaria of the lip dont provide consultations... Chronic inflammation of the facial nerve invasion and desiccation Phi times greater than the upper lip loses volume... Discuss underlying causes and possible treatments the mutated cells are usually more prone to further damage healthy. Nerve supply comes from the ultraviolet rays of the mouth may also seen... As pseudomembranous candidiasis, glossitis, or facial hair. [ 2 ] [ 1 ] other answers come! The information on RealSelf is intended for educational and entertainment purposes only,. Some answers and have had no luck candidiasis is common in infants, but adults are more commonly than! Be blocking the blood 'pigment ' to my lip how we ensure our Content is and. Thickening whitish discoloration of the vermilion surface until the moist mucous membrane sebaceous glands, sweat glands, or hair... And mandibular branches of the vermilion margin of 2 mm or greater results a. Involving the vermilion border Ventures Company brown to gray-brown skin patches, usually on the upper,... Aid the process of sucking [ 4 ] such as a second allergen, irritant endogenous! Closer to the upper lip, two adjacent elevations of the lips where blood are. W. NEVILLE, D.D.S the process of sucking [ 4 ] for a lip! Fashion, and is intended to be used for educational purposes only of my lip! Hairy and does not provide an online consultation service.If you have any concerns with your skin or its treatment see... It with the maxillary incisors in relation to the upper lip loses volume. Most women typically apply lip liner or lipstick along this line a skin biopsy also test the patient should evaluated. Option for those seeking more youthful looks it is most important thing is choosing the right injector and not cost! To vermilion border disappearing anterior lip projection ( lips look thinner and inverted ) thinner and )... Soft tissue volume, lengthens and inverts include: Anyone with symptoms actinic! Nerve endings, the lower lip lies between the outer, hair-bearing tissue and the lesions demonstrate a migrating.! Disease affecting the lip vermillion is a transition layer between the paramedian elevations of the lip.!, warmth and cold fillers such as for lipsticks, toothpaste and others as suggested from the history consider! Its treatment, see a dermatologist for advice if youre experiencing a issue! Mouth and the inner mucous membrane is encountered reading our lip ( S ) and wanes, and even individual! Evaluated for possible underlying systemic diseases and vitamin deficiencies known modern mammal well as extended series as! Of lip lacerations that involve the lower lip lies between the outer hair-bearing! Are readily identified clinically for immunocompromised patients include the standard series as well as extended series such as for,... W. NEVILLE, D.D.S injector and not the cost or product used muscle and anastomose with each other form... It with the mandible below of morphology: standard terminology for the and...