Main complaint and medical history:

A 60 year old male was referred from the undergraduate prosthetics clinic for evaluation of a lesion which may interfere with the construction of a complete upper denture. The patient’s previous denture was ill fitting and he complained it hurt his upper lip. He has stopped wearing it for just over a year prior to his initial prosthetics visit. Prosthetics had indicated that the lesion was noticed for some time and attributed it to the trauma inflicted to the site when occluding without his denture. The lower anterior teeth were over erupted and positioned anterior to the anterior maxillary edentureless ridge during full closure.

The patients’ medical history includes hypertension and a 40 year history of smoking >10 cigarettes daily. Alcohol is consumed on occasion. The denture was made over 10 years ago and placed immediately following dental extractions. He was never able to wear them comfortably and indicated that the labial flange began to feel increasingly uncomfortable last year.

Clinical examination:

Extra-oral findings included a noticeable swelling of the right upper lip affecting symmetry. An asymptomatic bilateral TMJ click was also detected on opening and closure. He appeared in good health but indicated he had lost around 2kg within th past 4 months as it was difficult to eat.

Intra-orally, a lesion was detected at the right upper labial mucosa. The lesion presented as a tender, fibrotic, slightly mobile swelling within the upper lip. The swelling could be visualised upon retraction of the lip and measured about 2cm. No surface lesion was detected upon examination but the patient indicated that the area did have an ulcer when he wore is dentures. Without dentures his lower anterior teeth occasionally caught the area when eating. Upon palpation, slight pain was felt. The patient then reported that pain occasionally flared up even without stimulation.

Teeth present 35 to 43 and 45 to 47 with gingival inflammation, recession, visible plaque and calculus. Mobility of tooth 47 (CL II) was detected but remained vital. A Class III occlusal scheme was apparent and exaggerated by the overeruption mandibular anterior teeth. The edentureless maxilla displayed moderate ridge resorption.

Figure 1: Lesion visible upon lip retraction left and combined with external palpation (Right)

Differential diagnosis:

  • Salivary neoplasia, benign or malignant
  • Related to chronic trauma; Nueroma


The patient was referred for FNA who indicated the possibility of salivary malignancy and advised biopsy to confirm.

Lesson learnt-The first case realising the importance of FNA for upper lip lesions