When i get some patient with big lip swelling, i remember my dental school class rooms where we were taught that upper lip is the dangerous area of face. Let me explain a bit — upper lip is part of dangerous area of face because of its peculiar venous supply which is directly connected to a part of brain called cavernous sinus and if there is some fulminating infection of upper lip which if not properly treated can travel up to brain causing thrombosis of cavernous sinus which is a life-threatening emergency.
Naturally, after leaving our dental classrooms, we used to get a bit scared when we used to see a patient with big lip swelling. Thank God, such infections no longer appear scary — i feel decades ago there were not effective broad-spectrum antibiotics so such infections once they set-up must have been difficult to manage which ultimately used to be life-threatening as discussed above.
Let’s look at this patient — he is a middle aged person with complaint of huge lip swelling with pain in one of upper front tooth, dental x-ray of which you are looking at on right side. The swelling is just of two days duration. With proper antibiotics and pain-killers-cum-anti inflammatory drugs, the swelling would come down in just 2-3days after which we can do proper treatment planning of this tooth.
But there is a big problem with Indians. They just want that fire be extinguished, that’s all. When i was telling this patient about the further management of this tooth once swelling and pain is gone, he seems totally disinterested in even listening to me.
The tooth was a bit shaky – and as you see in the above photograph there is acute inflammation of upper lip with associated swelling in the labial vestibule. Dental x-ray also reveals some bone loss and periodontal involvement. Of course, radical treatment of this tooth is going to be a bit cumbersome but if the patient is unwilling for any further intervention beyond relief and swelling part, then what can a dentist do!
Then what next? – such swelling will come up again — may be weeks, months or even years later and the cycle will go on till the time when the patient would become so frustrated with repeated bouts of pain and swelling or the tooth would become so shaky that it would required dental extraction.
The bottom line is acute infections involving upper lip are required to be promptly and adequately treated — it will always be dangerous area of face!