Makindo Medical Notes

General Considerations:

• Facial swelling: Swelling of the face or periorbital region can result from a wide range of conditions, including infections, allergic reactions, trauma, systemic diseases, and autoimmune conditions. The underlying cause determines the severity, associated symptoms, and required treatment.
• Unilateral vs Bilateral Swelling:
  • Unilateral: Often indicates localized issues like trauma, infection (e.g., cellulitis, abscess), or an underlying dental problem.
  • Bilateral: Suggests systemic causes such as allergic reactions, kidney disease (e.g., nephrotic syndrome), or autoimmune conditions (e.g., lupus, dermatomyositis).
• Periorbital swelling: This can be caused by local conditions such as conjunctivitis, trauma, or sinusitis. However, it can also be a sign of systemic disease (e.g., nephrotic syndrome or hypothyroidism).
• Associated Symptoms: Fever, pain, redness, itching, or vision changes may accompany the swelling, providing clues to the underlying cause.

Potential Causes

Red Flags:

• Sudden Onset of Severe Swelling: Particularly if accompanied by difficulty breathing, wheezing, or throat tightness, suggests a severe allergic reaction or anaphylaxis. Immediate medical attention is required.
• Vision Changes or Eye Pain: These symptoms, especially when accompanied by periorbital swelling, may indicate serious conditions like orbital cellulitis or cavernous sinus thrombosis. Urgent evaluation is needed.
• Fever and Malaise: Suggest an infectious cause, such as cellulitis or sinusitis, which may require antibiotic treatment. Orbital cellulitis can progress rapidly and needs urgent intervention.
• Facial Paralysis or Asymmetry: If facial swelling is associated with weakness or paralysis on one side of the face, consider Bell’s palsy or a more serious underlying neurological cause (e.g., stroke, tumour). Immediate medical attention is necessary.
• Persistent or Progressive Swelling: Ongoing, progressive facial or periorbital swelling without improvement over time may indicate an underlying systemic condition (e.g., hypothyroidism, nephrotic syndrome) or a malignancy (e.g., lymphoma, tumour compression). Further diagnostic evaluation is warranted.
• Signs of Superior Vena Cava Syndrome (SVC): Swelling of the face, neck, and upper chest with distended neck veins and difficulty breathing may indicate SVC syndrome, which requires urgent medical intervention, often due to malignancy or other causes of venous obstruction.