Lip Abrasions/Cuts/Puncture?

[AnthonyGTrombone]

Hello, long time reader, first time poster.
I apologize that this is a fairly long post, I want to give as much info as possible.
Hopefully this is the right sub forum for this.

TL;DR, bled in my mouthpiece for the first time. Been having a white spot form on my lip for the past year.
Goes away over time, but forms as soon as I do any loud playing. After a year today it finally opened and bled.
Looks like a popped pimple/scab.

I'm a 25 y/o freelance trombonist, gigging the past 7 years. So not quite totally green, but not yet a hardened vet.

I've unfortunately been developing a bit of a hot spot on my lips.
( I won't post a picture yet out of embarrassment but I will if I need to)
If memory serves I first felt the beginnings of this last summer (2022) working at a theme park.
I had never really played loud rock style trombone solos, and after 2 weeks of playing 5 shows every day, I started getting what I could only describe as a callous on the surface of my lip (not vermillion or where I place my mouthpiece) . It was white bump that was a little harder than the rest of my lip.
It went away with some rest.

By April of this year, I was playing another theme park gig, and day 1, before I even really got to playing much, it came right back. No blood or cuts, but it did start looking a little scabby at points.
I used neosporin, vitamin E tablets, water, ibuprofen, ice and various lip moisturizers and managed to keep things under control.
Again, after a couple of days of rest at home it went mostly away. It was still visibly a little more raw than other parts of my lip but after a month it looked all the same.

Now I'm at a point where any time I play a loud gig (playing in a nola style brass band currently), I can feel that spot swell up a bit, and usually after another day of more restful playing, it goes away.

Today it came to a head, I just played 2 brass band hits the last 2 days, and went up to play as a guest on a buddies gig this afternoon. Half way through the first tune, there was a good amount of blood in the mouthpiece.
Up to this point I hadn't had any blood.
I was able to finish the tune and scurry off. Currently typing with neosporin and ice for swelling.

It looks more like a puncture than a tear. Like someone popped a pimple or ripped a scab and there's a little dot where the blood is coming through.

As far as my playing goes, I do play fairly loud (always get hot in the moment), and try as I might the past 2 years, its been hard to let go of. It's never gotten me into trouble with directors or MD's or anything but it's always been noticed that I play "strong". That said, I don't feel like I'm playing with more pressure than other peers I have, and I don't think I play so loud as to cause issues like this, but I could be wrong. I can send videos if necessary. I don't practice too loud its usually a by product of adrenaline and hard to shake.

Here's the equipment I'm playing on and some physical descriptors of myself.
I play a Shires Q33 (.508), and I play a Marcinkiewicz 6E.
I have fairly full lips (Hispanic).

If anyone has experienced anything like this and can provide some advice that would be great.
Obviously playing softer would help but its truly been a struggle getting myself there, especially without something like an IEM to help monitor my own sound.

Any advice to bring down volume in the heat of the moment, gear changes I could consider, lip care, voodoo black magic, you name it I'll try it.

Thanks!

[Posaunus]

Have you thought of consulting a physician for this medical problem?

[AnthonyGTrombone]

Have you thought of consulting a physician for this medical problem?

It seems silly now that you mention it but no.

I think I hadn't considered it before because it seems like a strictly trombone related problem, and additionally I don't have a great primary care doctor at the moment.

My health insurance has me left with some slim choices and the doctor I've seen most recently has left a lot to be desired. Despite the 10 or so doctors visits I've had in the last 6 months, I've been entirely on my own with other medical conditions I've had.

[Doug Elliott]

I would first look at potential embouchure issues that could be causing the irritation. Consider possible sensitivity to silver. That probably wouldn't cause this problem but it could aggravate it.
And keep your mouthpiece clean.

[Crazy4Tbone86]

I know a couple of players who developed reactions to metal mouthpieces after years of playing with no problems. Their stories were similar……blisters, sores and sensitivity would worsen with more playing. If they took off time from the instrument, their lips would recover. When they started playing again the sores would come back again within a week.

They took different experimental paths to solve the issue. In the end, they both settled with polymer rims.

[harrisonreed]

It could be that your mouthpiece rim has abrasions or is dirty. It maybe you play with a lot of vibrato or a really wet embouchure.

[JohnL]

Where, exactly, is this spot?

Any change it could be shaving-related?

[Trombonjon]

I have a friend that had a problem similar to the one you described. Unfortunately, he did not have the luxury of being able to take time off as he's a very busy studio musician among other jobs. After several visits to different dermatologists and lots of money wasted on medications for the "blister," the last dermatologist he visited told him that those treatments would never work, because what he had was a wart and it needed to be burned. So he had it burned and that was the end of the problem.

[Wilktone]

Do you wet your lips before placing the mouthpiece? I wonder if more lubrication could help. Consider catching an online lesson with Doug Elliott just to have him scope out your chops and see if your embouchure technique has something going on that contributes. You might be working a lot harder than you need to to play.

[AnthonyGTrombone]

Thanks everyone for the wonderful replies! I will try to reply to everyone to hopefully provide all the info I can!

I would first look at potential embouchure issues that could be causing the irritation. Consider possible sensitivity to silver. That probably wouldn't cause this problem but it could aggravate it.
And keep your mouthpiece clean.

Doug, I'm currently playing on a gold mouthpiece, I should have mentioned that in the initial post. I use MI-T mist a few times a week, and then a rinse with some water.
I will note, that I seem to create a lot of dead skin on my mouthpiece. I usually have to spend quite a lot of time scrubbing off the inevitable crust even after just a couple gigs.

They took different experimental paths to solve the issue. In the end, they both settled with polymer rims.

I've been seriously considering this for other reasons. Did any of these players have this issue with gold? For the past 7 years I've only played my gold marcinkiewicz 6e on my small horn. My understanding is its hypoallergenic but who knows the purity of my mpc.
I don't do any crazy playing on my Bass Trombone or Tenor, however I do use silver mouthpieces on those.

It could be that your mouthpiece rim has abrasions or is dirty. It maybe you play with a lot of vibrato or a really wet embouchure.

I play with a lot of vibrato in my brass band yes. Very slow and wide, and I often don't use my jaw, my lips will pucker in and out to create the effect I want. I used to play with a very wet embouchure, using remedies like burts bees to play because my lips would get irritated. However... I stopped for some reason that escapes me now. I think I didn't like that I "needed" it to play.
My Mpc is fairly clean and smooth as far as I can tell and my blister is within the cup.

Where, exactly, is this spot?
Any change it could be shaving-related?

Its on my lower lip, near the middle crease. Slightly to the left. So not near any hair follicles.

because what he had was a wart and it needed to be burned. So he had it burned and that was the end of the problem.

I'm lucky that I typically work contracts, and teach. So in between contracts I've been able to rest.
That sounds terrifying though. I've heard of warts around the lip/vermillion, but I haven't heard of such an issue on the lip?

Do you wet your lips before placing the mouthpiece? I wonder if more lubrication could help. Consider catching an online lesson with Doug Elliott just to have him scope out your chops and see if your embouchure technique has something going on that contributes. You might be working a lot harder than you need to to play.

I definitely used to wet my lips a lot in college. In fact to the point it made my lips feel gross. So I started using things like Burts Bees to stop me from licking and getting more lubrication.
Within the last year or 2, I stopped using it, not really sure why. I guess I didn't want to "need it"
I'm not really sure if I'm licking my chops very much now adays, but maybe thats part of the problem?

I'll probably reach out to doug after I get a doctors check up.

[timothy42b]

I had something that sounds similar a little more than a year ago.

I thought it was either an allergic reaction to the mouthpiece or a mucocoele. It was painful enough to not want to play at all. (but I did) My doctor did not believe it could be either one; he was pretty sure it was mechanical damage.

Anyway, my doctor said three weeks of no playing. And after I returned to playing he suggested I moisturize before and after playing with something like eucerin. I've been using A&D for that.

There remains a small callous a year later but it is no longer painful and it doesn't get any worse. Kind of a long story but I suspect I caused it, and a bunch of mid range response problems, by doing some improper playing. That's also about the time I did several monthly lessons with Doug trying to sort it out and get back on the right track, and I think that playing more correctly may be why it hasn't been a problem.

[Doug Elliott]

I bet most people have never head of a mucocele but I have known players who had them.

From the Cleveland Clinc website:
An oral mucocele is a harmless mucus-filled cyst on the inside of your mouth. The cysts are usually painless and look like smooth, round lesions. Trauma such as biting your lip cause most oral mucoceles. You typically don’t need treatment because the cyst should go away by itself. Your provider can remove large cysts or ones that cause discomfort.

Not exactly "harmless" to a brass player..
And they're not necessarily only on the inside.

Google it to see pictures and descriptions. It's a possibility worth knowing about.

[KWL]

I bet most people have never head of a mucocele but I have known players who had them.

From the Cleveland Clinc website:
An oral mucocele is a harmless mucus-filled cyst on the inside of your mouth. The cysts are usually painless and look like smooth, round lesions. Trauma such as biting your lip cause most oral mucoceles. You typically don’t need treatment because the cyst should go away by itself. Your provider can remove large cysts or ones that cause discomfort.

Not exactly "harmless" to a brass player..
And they're not necessarily only on the inside.

Google it to see pictures and descriptions. It's a possibility worth knowing about.

I developed one during a time when I wasn't playing trombone. I guess I was lucky I had no issues with taking the time off for my surgery. Definitely something to look into. Cleveland says "inside of your mouth" but mine was right at the vermilion lip area while still "inside" of my mouth.

[AnthonyGTrombone]

I thought it was either an allergic reaction to the mouthpiece or a mucocoele. It was painful enough to not want to play at all. (but I did) My doctor did not believe it could be either one; he was pretty sure it was mechanical damage.

Kind of a long story but I suspect I caused it, and a bunch of mid range response problems, by doing some improper playing. That's also about the time I did several monthly lessons with Doug trying to sort it out and get back on the right track, and I think that playing more correctly may be why it hasn't been a problem.

I'm also experiencing mid range playing issues. They began around the time the first symptoms started appearing.
I figured they were indirectly related. That because I was taking off time to heal so often, that I wasn't maintaining good practice habits.

Pretty much over night the middle F Bb, and D partials woukdnt speak at all sometimes or are remarkably flat and bent. It felt like I'd have to blow incredibly fast air and make a very tight embouchure to produce these notes in tune. Everything felt very "heavy" in the sense I'd have to do a lot to get ascending lip slurs.
Past F things felt more normal. Accuracy was an issue but it didn't feel like a totally foreign embouchure.

Over the past 6 months I really tried to tackle that issue and I made a lot of progress. As it stands now, at my best the issues aren't present at all, and at my worst a 20 minute warm up gets things going again.

I bet most people have never head of a mucocele but I have known players who had them.

Not exactly "harmless" to a brass player..
And they're not necessarily only on the inside.

Google it to see pictures and descriptions. It's a possibility worth knowing about.

These pictures look exactly like what formed on my lips.
In fact, I remember taking a picture of it back in April, where it looked a little green. Likely filled with mucus. I remember one day I woke up and it had shrunk in size and there was a bit of fluid on my lip. Like a popped pimple. Not sure if I had accidentally popped it in my sleep.

These leads are going to be very helpful when I visit my doctor. I've scheduled a visit in 10 days with a new physician so hopefully I'll get some better treatment.

[AnthonyGTrombone]

Just wanted to update this thread after visiting my doctor, in case anyone has further advice, or in the future if someone is going back to read this thread with a similar problem.

Forgive me if my post is a bit jaded, but american healthcare is always a sore spot for me.

My doctor was, as expected, not particularly useful. I went to a different doctor at the center since I didn't really like my last one and this one wasn't any better.
I had brought up a mucocele or a wart, and mentioned how this sort of trauma is not a common physical reaction and my doctor didn't respond to that at all. They didn't really explain why they didn't think it was a mucocele, they kind of just ignored my comment and kept going with their script.
They suggested that I find some sort of "protection" for my lower lip because "this country has everything".
Not really sure what they were imagining there but maybe one of us should get to inventing that.

Jokes aside,
They went on to think its just overuse, and that at worst it could be Syphilis.
My symptoms don't match that at all of course, I guess its the only other mouth ulcer my doctor could come up with.
So I guess I may as well get tested for it for the sake of it.

I've got a lesson queued up soon and I'll be reaching out to Doug too to see what they think.
I also picked up some gear to help me out on stage. We'll see what happens!

Thanks for all your info, and if you have any post doctor advice, I'd love to hear it!

[Kbiggs]

Like Doug said, it sounds like a mucocele. It could also be some other kind of cyst or lesion that will continue to recur unless removed. A good dentist, oral surgeon, or even a knowledgeable ENT doctor would probably be more helpful than the doctors you mentioned.

It sounds like your recurring problem is on the red outside part of the lips, and is visible when you remove your mouthpiece. I've heard (perhaps here on TC?) that some people have had them surgically removed.

FWIW, I have a recurring mucocele on my lower lip. It's well inside the mouth, and rests about mid-tooth level on the first left incisor. I notice it about once every 9-12 months or so. I've managed by popping it when it shows itself, and then using hydrogen peroxide and a gentle mouthwash for a few days. If it starts to become more problematic I'll go see a sympathetic doctor.

[AnthonyGTrombone]

Like Doug said, it sounds like a mucocele. It could also be some other kind of cyst or lesion that will continue to recur unless removed. A good dentist, oral surgeon, or even a knowledgeable ENT doctor would probably be more helpful than the doctors you mentioned.

It sounds like your recurring problem is on the red outside part of the lips, and is visible when you remove your mouthpiece. I've heard (perhaps here on TC?) that some people have had them surgically removed.

FWIW, I have a recurring mucocele on my lower lip. It's well inside the mouth, and rests about mid-tooth level on the first left incisor. I notice it about once every 9-12 months or so. I've managed by popping it when it shows itself, and then using hydrogen peroxide and a gentle mouthwash for a few days. If it starts to become more problematic I'll go see a sympathetic doctor.

I think it likely is, and I'm hoping to have a lesson with Doug soon.
I am due for a dentist appointment soon, so I'll try and bring it up then! My PCP seemed not very useful.

And yes you are correct, its on the red outside part of my lower lip, just to the side of the middle "crease" so to speak. Its visible when I remove the mouthpiece, otherwise it would be inside the cup or perhaps just on the inside edge of the rim/cup.

I have another long and loud gig coming up so we'll see how I get on. I'd love for it not to make a return, but if it does, at the very least I'll be able to take some better pictures and get some more info.

[trombonedemon]

I'm interested in the pics. I grew a beard that covers a callous from when I played tenor, it formed from pressure playing. Which one of the reasons I switched to bass bone. Do you play with or perfer to have a dry embouchure?

[AnthonyGTrombone]

I'm interested in the pics. I grew a beard that covers a callous from when I played tenor, it formed from pressure playing. Which one of the reasons I switched to bass bone. Do you play with or perfer to have a dry embouchure?

I'll send you a private message!

I typically prefer to play with a wet embouchure, but I ran into issues licking my lips. It started causing irritations.
I used to play with burts bees to accomplish a good amount of lubrication and less licking but I stopped some time ago.
Now I'm unsure how wet my embouchure is when I play, it's not something I've kept too much track of.

[trombonedemon]

[trombonedemon]

When you are playing loud does your embouchure change dramatically. How much pressure are you using on a scale of 1-10. It would be helpful if you had pics with a mouthpiece and a beginning buzz as well. All of those pics, seems to be centered consistently, have you tried larger mouthpieces? Do you do much practicing in the mirror to avoid dramatic shifting?

[trombonedemon]

So many questions; someone really needs to see your approach, embouchure wise and text book wise to mouthpiece with the instrument. We can develop bad habits subconsciously even as pros and veterans of instrument.

[AnthonyGTrombone]

When you are playing loud does your embouchure change dramatically. How much pressure are you using on a scale of 1-10. It would be helpful if you had pics with a mouthpiece and a beginning buzz as well. All of those pics, seems to be centered consistently, have you tried larger mouthpieces? Do you do much practicing in the mirror to avoid dramatic shifting?

I have a bit of a shift in the lower register around F2, but I rarely play down there on those gigs.
I haven't tried a larger mouthpiece but I've wondered if something a little bigger would maybe put the pressure outside the lips more.

I do a little mirror practicing each day, but probably not more than just a few exercises to see if anythings weird.
I haven't noticed anything particularly egregious, but I'll admit I'm not the best at identifying things on looks.

As for pressure, I'd say I'm around a 6 or 7? Not enough to leave permanent marks on my lips, but enough for my lips to be a little tender the next day where I placed the mouthpiece.

I have a lesson with Doug this wednesday so we'll see what he says and maybe I'll post some videos after that with my experience and thoughts.

[trombonedemon]

When you are playing loud does your embouchure change dramatically. How much pressure are you using on a scale of 1-10. It would be helpful if you had pics with a mouthpiece and a beginning buzz as well. All of those pics, seems to be centered consistently, have you tried larger mouthpieces? Do you do much practicing in the mirror to avoid dramatic shifting?

I have a bit of a shift in the lower register around F2, but I rarely play down there on those gigs.
I haven't tried a larger mouthpiece but I've wondered if something a little bigger would maybe put the pressure outside the lips more.

I do a little mirror practicing each day, but probably not more than just a few exercises to see if anythings weird.
I haven't noticed anything particularly egregious, but I'll admit I'm not the best at identifying things on looks.

As for pressure, I'd say I'm around a 6 or 7? Not enough to leave permanent marks on my lips, but enough for my lips to be a little tender the next day where I placed the mouthpiece.

I have a lesson with Doug this wednesday so we'll see what he says and maybe I'll post some videos after that with my experience and thoughts.

Neat. Keep notes and let us know what he says. This good information for all of us trombonist!!!

[trombonedemon]

Did you get that lesson?

[AnthonyGTrombone]

Did you get that lesson?

Hey, I did get a lesson.
I definitely learned a lot.
A lot of Doug's lesson was tailored to my playing in specific so perhaps not super useful to others but here's a summary of what was going on with me.

My embouchure moves around a lot. There's a fair amount of movement at the corners stretching and pressing.
Doug gave me some exercises and some anatomy/physics lessons to help take some of this movement out.
Namely with the tongue placement and some angling of the horn.

A gear change was made to help this along that was pretty specific to my embouchure type and anatomy.
a wider and shallower mouthpiece was Doug's recommendation to me. One with a narrow rim since I play so close to my nose
I haven't had the time to really learn that mouthpiece yet, as I'm in rehearsals for a tour and can't afford the inconsistency. Hopefully soon I can make the switch and get used to it.

There was some other stuff discussed but this is what's directly relevant I think to the lip ulcer.

So far I've had minimal issues on my lips, but occasionally see a little discoloration and feel a certain numbness after a lot of playing that goes away (perhaps blood is being restricted to this part of my lip while playing? )
I think the gear change will help and I think mindful playing will help.

In general my take away has been to make more happen behind the teeth instead of at the corners.
Whenever my air is lined up well and my tongue is in the right spot, I wind up needing less embouchure movement. Similar to whistling.

Anybody struggling with a similar issue of embouchure collapse, or some physical issues like my lips could definitely stand to take a lesson with Doug as his approach is individual and tailored to each player and that's very helpful.

I'll also point out this is just my abbreviated interpretation of Doug's lesson for me so take it with a grain of salt since I could be mistaken in my understanding of something.

[trombonedemon]

I'm it worked out, he confirmed all of my sneaky suspicions!