FACIAL SWELLING
Ask the Following Questions:
- Is the facial swelling focal or diffuse? If it is focal, one should consider a local condition in the structures underlying the face such as the salivary glands, the teeth, or the sinuses. Mumps is a common condition, of course, especially in children. If it is diffuse facial swelling, one should consider a systemic disease such as glomerulonephritis, myxedema, or Cushing's disease.
- Is the swelling associated with generalized edema? If there is generalized edema, one must consider acute glomerulonephritis, nephrotic syndrome, congestive heart failure, or cirrhosis. If the generalized edema is nonpitting, one would consider myxedema and cretinism. If there is no generalized edema, one must consider conditions such as Cushing's syndrome, dermatomyositis, acromegaly, mongolism, and Paget's disease.
- If the edema is generalized, is it pitting edema or nonpitting edema? Nonpitting edema would suggest myxedema and cretinism.
- Is there associated flushing? With flushing one would consider Cushing's syndrome, dermatomyositis, and a superior vena cava syndrome. If there is no flushing, one should consider acromegaly, mongolism, or Paget's disease.
- Is there associated fever? If there is associated fever, look for infections in the structures underlying the skin such as mumps, abscess of the salivary gland, an abscessed tooth, sinusitis, or syphilis.
DIAGNOSTIC WORKUP
Cases of focal swelling should have a routine CBC and sedimentation rate. X-rays of the sinuses and teeth should be done. If mumps is suspected, a mumps skin test or antibody titer may be done. If all these tests are negative and there is a focal swelling, referral to an oral surgeon may be wise at this point.
If the swelling is diffuse, the basic workup is a CBC, chemistry panel, and urinalysis. A streptozyme test or ASO titer can be done if glomerulonephritis is suspected, but a microscopic examination of the urine is extremely important in this condition. If congestive heart failure is suspected, a chest x-ray, EKG, arm-to-tongue circulation time, and pulmonary function testing should be done. In cases of Cushing's disease, a serum cortisol and cortisol suppression test may be done. X-rays of the skull and long bones should be done in suspected cases of acromegaly or Paget's disease.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
Other Book Chapters Related to Face swelling
Read excerpts from these other book chapters related to Face swelling:
Medical Books Excerpts
- FACE PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Facial pain
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Edema, facial
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Facial pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.
More About Causes of Face swelling
» Next page: FACIAL PAIN (Differential Diagnosis in Primary Care)
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