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There are a wide variety of inflammatory, infectious, and cystic lesions which may lead patients to seek acute care for facial swelling. Computed tomography (CT) has become the mainstay for imaging in the urgent/emergent setting. However, magnetic resonance imaging (MRI) can also serve as a powerful problem solving tool in the modern era. As volume continues to increase, a wide variety of facial pathology will be encountered by the emergency radiologist. Recognition of both common and uncommon pathology will assist in diagnosis and value-based care. This article serves as an image-rich review of the many causes of facial swelling with an emphasis on key imaging findings and possible complications.

Background We investigated the efficacy of a maxillary Jackson-Pratt (J-P) suction drain for preventing maxillary sinus hematoma and facial swelling after maxillary Le Fort I osteotomy (LF1). Methods We retrospectively evaluated 66 patients who underwent LF1 at a single institution. Of these, 41 had a J-P suction tube inserted in the mandible and maxilla (maxillary insertion), and 25 had a J-P drain inserted in the mandible only (no maxillary insertion). Facial CT was obtained before and 4 days after surgery. We compared mean midfacial swelling and maxillary sinus haziness by t test and examined correlations between bleeding amount and body mass index (BMI). Results For the maxillary-insertion group, the ratio of total maxillary sinus volume to haziness (57.5 ± 24.2%) was significantly lower than in the group without maxillary drain insertion (65.5% ± 20.3; P = .043). This latter group, however, did not have a significantly greater midfacial soft tissue volume (7575 mm3) than the maxillary-insertion group (7250 mm3; P = .728). BMI did not correlate significantly with bleeding amount or facial swelling. Conclusions Suction drainage in the maxilla reduced maxillary sinus haziness after orthognathic surgery but did not significantly reduce midfacial swelling.

The above article was published online with inverted figures legends for Fig. 1–6. The correct presentation is shown below. The original article has been corrected.

In England there were 7,290 cases of tuberculosis (TB) reported in 2013. The area with the highest incidence of the disease in England is London, with hotspots in other urban areas. TB affecting the head and neck is rare. We present three such cases of TB presenting as pre-auricular swelling. Two of the patients were initially misdiagnosed as having dental infection, demonstrating the importance of taking a good history and considering the differential diagnosis of TB when appropriate. TB remains a potentially fatal disease that should be considered in patients presenting with facial swelling where common causes have been excluded.

To determine the characteristics, aetiology and management of facial swellings of odontogenic origin in the paediatric population. Prospective study of children with facial swellings of odontogenic origin. All children who presented to the Departments of Paediatric Dentistry of the Westmead Centre for Oral Health and the Children’s Hospital at Westmead with a facial swelling of odontogenic origin over a 12 month period were identified and included in the study. Treating clinicians completed a standardised data collection sheet to record information relating to patient demographics, medical history, dental history, history of current episode of facial swelling of odontogenic origin, examination findings and management. Data were entered in Microsoft® Excel and statistical analysis carried out using Statistical Analysis Software® version 9.3. Two hundred and fifty-three children were included in the study, with a mean age of 6.3 years. Sixteen percent of children were admitted for intravenous antibiotics, surgical management and supportive care. For the remaining children not admitted, a range of management approaches were undertaken. These included immediate surgical management with or without oral antibiotics, delayed surgical management following a course of oral antibiotics, or oral antibiotics alone, where the cause of the odontogenic infection had already been removed. For 2 % of children, a delayed surgical management approach was unsuccessful and the children were admitted. Management options for children presenting with facial swellings of odontogenic origin include admission to hospital for intravenous antibiotics and acute surgical management, immediate surgical management with or without a course of oral antibiotics or initial management involving a course of oral antibiotics, with definitive dental treatment being provided after resolution of the acute odontogenic infection.

Although the extraction of an impacted third molar (3M) is a routine procedure, postoperative morbidities typically include swelling, pain, and trismus. The aim of the present study was to investigate whether the application of kinesiologic tape can improve the postoperative morbidities associated with 3M surgery, thereby improving the postoperative well-being of patients. Forty patients assigned for prospective 3M removal were randomized into two treatment groups (with/without kinesiologic tape). Facial swelling was quantified using a five-line measurement at six specific time points. Pain scores were assessed using a visual analog scale, and mouth opening range was assessed by means of standard calipers. In addition, all patients were asked to evaluate overall satisfaction and swelling (both groups) and the effect of the tape on movement and comfort (taped group only). The postoperational application of kinesiologic tape reduced significantly all investigated parameters: swelling, pain, and trismus. Furthermore, patients with kinesiologic tape reported a significantly lower morbidity rate. The application of kinesiologic tape following a 3M surgery is a simple and economical, yet medically relevant approach. Kinesiologic tape offers patients a less traumatic postoperational experience and therefore holds promise to enhance the quality of life of a large cohort of the population.

Purpose: The aim of this study was to compare the influence of triangular and envelope flaps on trismus, pain, and facial swelling after mandibular third molar surgery. Methods: Twenty healthy patients with bilateral, symmetrically impacted mandibular third molars were included in this double-blinded, prospective, cross-over, randomized study. The patients were operated with envelope flap on one side and triangular flap on the other side. Trismus was determined by measuring maximum interincisal opening, and facial swelling was evaluated using a tape measuring method. Pain was determined using visual analog scale (VAS) and recording the number of pain pills taken. Results: The facial swelling measurements and VAS scores were lower in the envelope flap group compared to the triangular flap group. There was no significant difference between the two flap designs in operation time, maximum interincisal opening, and the number of analgesics taken. Conclusion: Envelope flap yields to less facial swelling and reduced VAS scores in comparison to triangular flap. There is no clinical difference in trismus between the two flap designs. Despite the higher VAS scores with triangular flap, no additional doses of analgesics were required in triangular flap. © 2011 Springer-Verlag.

Non-inflammatory swelling in the head and neck area are usually caused by allergic angioedema. However, other differential diagnoses must always be considered. Superior vena cava syndrome is a rare differential diagnosis of angioedema. Since we treated two such patients within only a few weeks of one another with the initial supposition of an ACE inhibitor-induced angioedema, but who ultimately proved to have lung cancer, we would like to draw attention to this disease pattern.

Das hereditare angioneurotische Odem wird durch einen Mangel oder Dysfunktion des C1-Esterase-Inhibitors hervorgerufen. Dabei kommt es u. a. durch unkontrollierte Aktivierung des Komplementweges zu erhohten Bradykininspiegeln und Odembildung. Wir berichten uber eine Patientin mit massiven Schwellungen im Gesicht und akuten gastrointestinalen Symptomen. Therapie der Wahl ist bei Beteiligung der oberen Luftwege die Sicherung der Atemwege und Substitution von C1-Esterase-Inhibitor-Konzentrat. Behandlungen mit Glukokortikoiden, Antihistaminika und Adrenalin sind unwirksam.

Subcutaneous emphysema is characterized by the presence of air or other gases in the subcutis after a spontaenous or traumatic interruption in a air-carrying structure. We describe a patient who developed unilateral facial swelling after dental treatment. Considering the history, differential diagnostic possibilities and the physical examination, we diagnosed cervicofacial emphysema.

Arici, Selim/0000-0001-8890-2065 WOS: 000222851300010 PubMed: 15243609 Objective This study was undertaken in order to evaluate the effects of local haemostasis on the facial swelling induced in patients undergoing surgical removal of impacted mandibular third molar teeth. Design A prospective randomised cross-over study. Setting Department of Oral and Maxillofacial Surgery, Samsun, Turkey, 2002. Materials and methods Twenty-five healthy patients who were having bilaterally symmetric, impacted third molar extraction were studied. The teeth were removed in two separate operations by two surgeons who had equal academic degrees. The patients were assigned to test and control groups by random selection. One side served as control and on the other local haemostasis was achieved by a haemostatic agent ( oxidised regenerated cellulose). This was placed into the socket following gauze packing for 3 minutes ( test). The operating time therefore significantly increased in the test group. Data was collected regarding the operating time, mouth opening and facial swelling. Results There were no statistically significant differences between the test and control groups for the mean values of the facial swelling and mouth opening at day 1 and 3 post-operatively ( P > 0.05). Operating time was statistically longer for the test group than the control ( P < 0.001). Conclusion This study has shown that establishment of local haemostasis after removal of impacted mandibular third molars is not so effective in preventing facial swelling.

We identified 51 patients from pathology and operative records who were treated in the Royal Victoria Eye and Ear Hospital with malignant sinonasal tumours between January 1980 and December 1991. Complete follow up was available in 43 patients. There were 30 males, mean age 50 years, range (10-80) and 13 females, mean age 59 years, range (34-75). Commonest presentations were nasal obstruction, nasal discharge and facial swelling. Patients presented late because of initial non specific symptoms. The maxilla was the site of origin in 18 patients, the ethmoids in 13 patients and the nasal cavity in 12 patients. There was a wide range of histological types with squamous cell carcinoma occurring in 19 patients (44%). All patients were treated with surgery, radiotherapy or a combination of both. Chemotherapy was used as an adjunctive therapy in three patients. Local recurrence occurred in 21 (50%) of the patients. Overall three year survival was 58% and five year survival was 45%. These figures compare favourably with larger series in the literature. A high index of suspicion, early recognition and referral of these patients is required to improve survival.

Many disease processes can present with facial swelling and multiple discharging sinuses. A differential diagnosis would include actinomycosis, tuberculosis and osteomyelitis, but tinea barbae is a relatively uncommon presentation.The following case report describes a 48-year-old jockey who was diagnosed with tinea barbae. It chronicles the investigations that were performed to determine the offending pathogen and the difficulty in achieving a diagnosis.The investigations and the pathophysiology of dermatophytic infections and their management in a maxillofacial/oral medicine environment are discussed.

A middle aged immune-competent woman presented with a facial swelling, which was excised. The histopathology showed it to be a non-caseating granuloma. PCR confirmed that the swelling was caused by mycobacterium other than tuberculosis (MOTT) infection. No relapse was seen on follow up even without chemotherapy.