Facial Swelling: Symptoms, Complaints, Signs

The following symptoms and complaints may occur together with facial swelling:

Leading symptom

  • Facial swelling; this can be differentiated as follows:
    • Location of localization (e.g., forehead, eyelid, cheek, lip).
    • Type of swelling:
      • Localized
      • Diffuse (evenly distributed)
    • Painfulness:
      • Yes
      • No

Associated symptoms

  • Erythema (areal redness of the skin)
  • Fever
  • Lymphadenopathy (lymph node enlargement)

Caveat.

  • In case of purulent inflammation of the orbit, intravenous therapy with antibiotics must be given.
  • If herpes zoster with involvement of the ophthalmic nerve (zoster ophthalmicus) is suspected, antiviral therapy (see below herpes zoster/pharmacotherapy) and referral to an ophthalmologist must be made immediately.

Warning signs (red flags)

  • Anamnestic information:
    • Dental treatment → think of: Dental abscess (tooth abscess)
  • Fever + (unilateral or bilateral possible) → think of: Parotitis epidemica (mumps).
  • Occurrence bilaterally → think of: Quincke’s edema (angioedema; often massive swelling of the subcutis (subcutaneous tissue) or submucosa (submucosal connective tissue), which usually affects the lips and eyelids, but may also affect the tongue or other organs).
  • Slowly developed facial swelling + painless bloody-serous discharge from the nose → think of: malignant neoplasm.
  • Slowly developed painless facial swelling → think of: Neoplasm or cyst
  • Swelling of the parotid gland (parotid gland) + facial paralysis → think: malignant neoplasm of the parotid gland with involvement of the facial nerve
  • Swelling increases with eating → think of: Sialolith (salivary stone)