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A 53-year-old man presented to the accident and emergency department with sudden onset left-sided facial nerve palsy and a 4-day history of progressive bilateral facial swelling. There is no history of any previous medical conditions, trauma or recent travel. What is the most likely Diagnosis seen in figures 1 and 2? 1. Bell’s Palsy. 2. Stroke. 3. Vasculitis. 4. Parotid abscess. For question see page 02 Figure 1 Patient presentation with bilateral facial swellings and facial nerve palsy. Figure 2 Clinical findings when …

The following is a case report of a 17-day-old female baby, born at 35 weeks' gestation, weighing 2.6 kg. She was brought to us with reluctance to feed, swelling over the left side of her face and a fever documented at 102oF, along with an erythematous, tender, localised swelling over the left pre-auricular region that measured 2 x 1.5 cm in size. Diagnostic workup and ultrasound findings were consistent with parotitis; however, her blood culture was negative. The patient was managed on antibiotics but subsequently, developed a nosocomial infection while she was admitted in the hospital, which prolonged her hospital stay to a total of 16 days. Nevertheless, she had complete resolution of the signs and symptoms on her follow-up visit. Acute parotitis should be considered in the differential diagnosis of a neonate presenting with facial swelling, reluctance to feed or incessant crying. Timely and appropriate management can result in good recovery and minimising the potential for complications.

INTRODUCTION: Adverse events associated with vaccine administration can manifest in the oral cavity and orofacial region. Hence, the aim of this study was to compare the orofacial adverse effects of two recently authorised COVID-19 vaccines, namely BNT162b2 and mRNA-1273. METHODS: Publicly available data on BNT162b2 and mRNA-1273 vaccines were accessed from the relevant regulatory authorities in the United States, Canada, European Union and United Kingdom. Both patient/recipient information and healthcare professional fact sheets for each of these drugs were manually searched to find their orofacial adverse effects. RESULTS: Adverse events affecting the orofacial region were reported for both vaccines. These were rare and included acute peripheral facial paralysis (Bell's palsy), facial swelling, and swelling of the lips, face or tongue associated with anaphylaxis. There was heterogeneity in the acknowledgement of vaccine-related adverse events in North America compared with Europe. CONCLUSION: Globally, there are inconsistencies in the description of adverse effects presenting in the orofacial region of the COVID-19 vaccines BNT162b2 and mRNA-1273. We believe that awareness of these orofacial manifestations will improve recognition, management and reporting of vaccine-related adverse effects.

Chronic non-bacterial osteomyelitis (CNO) is a rare and difficult-to-diagnose disease, especially when limited to the jaws. We report the case of a 5-year-old girl with spontaneous jaw pain and a large pre-auricular facial swelling overlying the angle of the mandible that was non-responsive to previous antibiotic and non-steroidal anti-inflammatory treatment. The diagnosis was confirmed as CNO following evaluation and workup by a multidisciplinary team. The patient exhibited a favourable response to oral alendronate sodium plus vitamin D3 combination treatment. We believe that alendronate sodium is an effective second-line drug for CNO.

This case study describes a 24-year-old woman who presents to her primary care provider with marked unilateral facial swelling that has been present for 6 months. Facial swelling is a frequently observed symptom associated with various odontogenic and nonodontogenic conditions. Appropriate diagnosis and referral are critical when patients seek care for a suspected oral pathology.

Background Rhinofacial entomophthoramycosis is a specific fungal infection of the skin and subcutaneous tissue. It is considered as a rare and neglected disease in tropical and subtropical areas. We would like to present our cases to aid other physicians in the improved recognition of typical cases. Materials and methods A retrospective review was performed on patients with the diagnosis of Conidiobolomycosis or Entomophthoramycosis in Chiang Mai University Hospital, Thailand, from January 2009 to May 2019. There were seven cases with a definite pathologic report or culture in this review. Results All seven patients were men and were referred to the university hospital for diagnosis. The mean age was 53 ± 15.7, ranging from 27 to 71 years. Most of the patients (85.7%) presented first with nasal or rhinofacial swelling and nasal obstruction. The definite diagnosis came from clinical presentation and investigation with a tissue biopsy, culture and communication among physicians. Patients responded well with a combination of medical treatment, including potassium iodide (KI), co-trimoxazole, or itraconazole. Conclusion Rhinofacial entomophthoromycosis or Conidiobolomycosis typically can be diagnosed under a suspicious clinical presentation. The obvious clinical response can be seen within several weeks after medication., Highlights • Rhinofacial entomophthoramycosis or Conidiobolomycosis is uncommon disease, but commonly presented with facial swelling. • Typical clinical presentations were demonstrated to help other physicians in the improved recognition and diagnosis. • This is a disease that once known, will not be forgotten.

Background The purpose of this publication is to report on the six-month clinical results and patient reported outcomes (PROs) comparing the surgical use of the Er,Cr:YSGG laser (ERL) and minimally invasive surgical technique (MIST) for the treatment of intrabony defects in subjects with generalized periodontitis stage III, grade B. Methods Fifty-three adult subjects (29 females and 24 males; 19 to 73 years) with 79 intrabony defects were randomized following scaling and root planing (SRP) to receive ERL monotherapy (n = 27) or MIST (n = 26). Recession (REC), probing depth (PD), clinical attachment level (CAL), treatment time, and PROs were assessed and compared for each treatment group. Clinical measurements were recorded at baseline, 4-6 weeks following SRP, and six months following surgical therapy. Results The following primary and secondary outcome variables were non-inferior with the following margins: CAL with a non-inferiority margin of 0.6 millimeters (mm). (p = 0.05), PD with a non-inferiority margin of 0.5 mm. (p = 0.05), Recession with a non-inferiority margin of 0.4 mm (p = 0.05). Faster procedure times were found for ERL (16.39 ± 6.21 minutes) vs MIST (20.17 ± 5.62 minutes), p = 0.0002. In the first two to three days of post therapeutic diary outcomes, subjects reported less bruising, facial swelling, and use of Ice pack for the ERL group. Conclusions This is the first multicenter, randomized, blinded, and controlled study demonstrating the Er,Cr:YSGG laser is not inferior to MIST in terms of clinical outcomes but is superior in PROs for the surgical treatment of intrabony defects. This article is protected by copyright. All rights reserved.

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.

A 35-year-old female with pulmonary arterial hypertension (PAH) who presented with complaints of progressively worsening dysphagia, facial swelling, and shortness of breath, was found to have a large goiter. In patients treated with epoprostenol for long periods of time, thyroid disease is common. Most cases of thyroid disease describe thyrotoxicosis and hyperthyroid statues, but our case was a patient on long term IV epoprostenol presenting with a superior vena cava-syndrome (SVC) like appearance and airway compromise found to have a goiter incidentally during workup.

Placing objects in the mouth by children get accidentally implanted in the oral cavity, ingested, or aspirated. The incidence of foreign bodies is usually higher in the zone of head and neck than other regions of the human body. Usually, foreign bodies are symptomatic and signs of inflammation pain and purulent discharge are shown. This paper describes an unusual case of traumatic foreign body (pen cover) accidently moved in the retromolar area causing recurrent facial swelling, purulent discharge, and reduced mouth opening. How to cite this article Gupta G, Gupta DK, Bhat M, et al. Traumatic Impaction of Unusual Foreign Body in a 10-year-old Boy's Mouth: A Case Report. Int J Clin Pediatr Dent 2020;13(4):433-436.

Osteomas are an uncommon benign neoplasia in horses, which most frequently affect the paranasal sinuses. There are only 25 reported cases in the literature. Clinical signs typically associated with paranasal osteoma formation include nasal discharge, ocular and/or facial swelling and distortion. Historically, surgical excision under general anaesthesia has been the standard approach for the treatment of large osteomas with standing surgery reserved for small masses. This case report describes standing removal of an extensive paranasal osteoma through a maxillary bone flap, without recurrence. Long-term follow up at 2 years confirmed a good cosmetic appearance and successful return to racing.

The differential diagnosis for facial swelling is broad and can be a diagnostic challenge in the pediatric emergency department. We describe the first pediatric case of acute parotitis with sialolithiasis where the diagnosis was facilitated by point-of-care ultrasound.

Administration of hyaluronic acid (HA) filler for aesthetic lip augmentation is a routine and common procedure with a low rate of adverse reactions. This case report documents an extremely rare complication of lip augmentation with HA leading to the development of lymphangiomas. Lymphangiomas are uncommon hamartomas of the lymphatic system. Although usually congenital, they can be acquired due to trauma, inflammation, or lymphatic blockage. They may be in the deep or superficial tissues, with superficial forms being either lymphangioma circumscriptum or acquired lymphangioma, also referred to as lymphangiectasia. Acquired lymphangiomas are typically formed by blockage of lymphatic drainage leading to dilation of the lymphatic channels. The diagnosis in our case report is acquired lymphangioma. A 27-year-old female presented with a two-year history of linear swellings in her upper lip. These lumps followed the line where HA filler had been injected four years earlier. Hyaluronidase had previously been used unsuccessfully to remove these lumps. The patient was treated with surgery to excise the lesions. Five masses were excised, and histopathological analysis displayed the presence of variably ectatic lacunae, lined by cells with CD34 expression, a lymph-vascular-endothelial marker. There were also scattered macrophages with CD68 expression in the interstices. These are typical features of a lymphangioma. The patient was satisfied with the excellent aesthetic and functional outcome. To our knowledge this is the first case of a lymphangioma following HA lip augmentation. Although rare, this complication can have aesthetic implications for the patient which may require further treatment or surgery to correct.

Any facial swelling is associated with stress for the patient due to cosmesis. Especially when one has bilateral symmetrical enlarged parotids, having exhausted all available conservative management, surgery becomes the last resort; which in such cases pose specific challenges. A 29-year-old man presented with problems of bilateral symmetrical enlarged parotid lesion for 5 years, which did not have an adequate response to medical line of management. He underwent proposed surgery and was diagnosed to have chronic sclerosing parotitis (CSS). The challenges faced during surgery of this non-neoplastic inflammatory lesion, with significant fibrosis, is being described. He recovered completely without any complications related to surgery. CSS rarely affects bilateral parotid glands. Surgery, results of which are outstanding, must be considered in cases where these lesions do not respond to medical line of management. Bilateral total conservative parotidectomy with sternocleidomastoid flap reconstruction provides excellent aesthesis and improves quality of life.

Malignant pericardial sarcomatoid mesothelioma is a massively rare tumor accounting for 0.8% of all cases of mesothelioma. Superior vena cava syndrome (SVCS) occurs due to a partial obstruction or compression to the superior vena cava, which hinders the blood outflow to the upper body. It can be caused by an intrinsic factor such as thrombosis, or by an extrinsic factor such as tumors. Clinical presentation includes edema of the face and upper limbs, plethora, dyspnea, dysphagia, stridor and cough. we are reporting a case of a 56-year-old female, who is a known case of hypertension on angiotensin-converting enzyme inhibitors (ACEIs). Presented to the emergency department with intermittent facial swelling and dyspnea. Imaging and pathology reports confirmed the diagnosis of intermittent SVCS secondary to pericardial sarcomatoid mesothelioma with pericardial effusion. What makes our case unique is that both the etiology and the presenting complaint are rare entities, as most SVCS cases are continuously symptomatic throughout the disease course, and are usually caused by a lung cancer or lymphoma.

Facial swelling has several etiologies. In patients with head and neck malignancies, this can include primary disease progression or iatrogenic causes. A 66-year-old man presented with increased facial swelling and erythema for 18 months. He had a history of baseline postoperative facial lymphedema following head and neck surgery and radiotherapy for desmoplastic melanoma approximately 20 years ago. However, his facial edema acutely worsened 18 months prior to presentation. A medication review revealed that he was regularly taking melatonin for the past two years. Approximately two weeks after cessation of melatonin therapy, the patient's facial appearance returned to baseline. In conclusion, it is important for clinicians to perform a thorough medication review for patients with facial swelling and erythema.

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.

This 79-year-old woman with sarcoidosis presented to the ENT (ear, nose and throat) outpatient service with increasing unilateral right-sided facial swelling and nasal obstruction, as shown in [figure 1][1]. Four years previously she had been treated for unilateral sinus disease on the right, and

Angioedema resulting in oral and facial swelling with possible airway compromise can be either hereditary or acquired. Hereditary angioedema is an autosomal dominant disease and results from an inh...

Immunoglobulin G4-related disease (IgG4-RD) is a new disease entity of rare and complex immune-mediated fibroinflammatory conditions that can affect any organ. The concomitance of IgG4 sclerosing sialadenitis and dacryoadenitis with rhinosinusitis is extremely rare. We report a case of IgG4 sclerosing sialadenitis and dacryoadenitis (Mikulicz’s disease) diagnosed in a middle-aged African American man with a long-standing history of chronic rhinosinusitis who presented with progressively worsening bilateral salivary and lacrimal glands swelling. Imaging revealed pansinusitis, symmetric enlargement of the lacrimal glands, parotid glands, and submandibular glands. Serological IgG4 level was significantly elevated and the diagnosis of IgG4 sclerosing sialadenitis was confirmed by histopathology. A robust clinical response in the facial swelling and nasal manifestations was noted after the initiation of immunotherapy with corticosteroids.

Inflammatory pseudotumor (IP) is a clinically aggressive but histologically benign condition of unknown cause. It rarely appears in the nasal cavity and sinuses. Here, we describe a 24-year-old female with the main symptom of right nasal obstruction. Examinations showed dilation in the right maxillary sinus and a pale neoplasm in the nasal cavity. The neoplasm was completely excised under endoscope. Postoperative pathology showed significant proliferation of plasma cells and lymphocytes, indicating the presence of IP. No recurrence was found during 20 months of follow-up. Only 28 cases (10 males and 18 females, average 41.04 years) have been reported on Pubmed. The main clinical manifestations were nasal obstruction, epistaxis, facial swelling and pain, eyeball protrusion, diplopia, and other ocular symptoms. Inflammatory pseudotumor always erodes the surrounding bone and requires active treatments. Surgery is the optimal option with a good prognosis.

A five-year-old male presenting with progressive right facial swelling underwent multiple biopsies before being diagnosed with a polyostotic frontal-zygomatic primary intraosseous hemangioma. Intraosseous hemangiomas are rare, more frequently afflict adult females, and very rarely involve the orbit. Our case with bony destruction and surrounding soft tissue mass measured 5.3 cm in a child mimicked a more ominous malignancy. This case is unique with its rapid progression and largest reported size, leading to additional challenges such as difficulty in achieving an adequate tissue sample and in the surgical management with respect to significant blood loss in a small child.

We present a 32-year old woman with a 9-year history of upper facial swelling. A workup by the ophthalmology department led to the diagnosis of Melkersson-Rosenthal syndrome. Re-evaluation in our dermatology clinic confirmed a diagnosis of Morbihan disease. Herein, we review case reports and case series of upper facial swelling in the dermatologic and ophthalmologic literature. Although the two entities share histopathological changes, they tend to have different clinical presentations. Melkersson-Rosenthal syndrome appears to be more likely diagnosed in the ophthalmologic literature when the clinical presentation and histopathology may be more consistent with Morbihan disease. In a patient with upper facial swelling, an absence of orolabial swelling, and lack of facial neuropathy, we argue for a diagnosis of Morbihan disease over Melkersson-Rosenthal syndrome, especially if the patient has a history of rosacea.

A 31-year-old pregnant woman at term, G2P1, is sent from clinic to Labor & Delivery (L&D) because of preeclampsia, with a blood pressure of 180/100, proteinuria, sudden weight gain, a severe frontal headache, and facial swelling. In clinic the week before, her BP had been 118/72 and her earlier blood pressures during pregnancy had all been normal. In the clinic they gave her acetaminophen for her headache, but on arrival in L&D she says that there has been no improvement in her pain.

Acute otitis media is a localized infection. Advanced cases demonstrate local spread and abscess formation in the mastoid, temporomandibular joint, and zygomatic root if anatomy allows. We present a case of acute otitis media complicated by an abscess of a pneumatized zygomatic root extending into the temporomandibular joint treated by incision and drainage.

The aim of this study was to evaluate the effect of phototherapy on bite force, facial swelling, mandibular movements, and pain in patients having undergone surgical treatment for mandibular fractures.These are among the predominant types of facial fractures, and treatment involving surgical fixation with titanium plates is one of the most common procedures in oral-maxillofacial surgery. Phototherapy has been used to accelerate the muscle healing process and significantly improves muscle regeneration by inducing the formation of new muscle fibers.The patients were divided into two groups: Group 1-active phototherapy, and Group 2-sham phototherapy. Both groups underwent the surgical procedure by the same surgeon using the same surgical technique. Dosimetric parameters are wavelength, 660 nm; power, 108 mW; radiant energy, 21.6 J; fluency, 21.6 J/cmThe primary variable was bite force measured with a gnathodynamometer and the secondary variables were facial swelling, mandibular movements (measured with digital calipers), and pain. The Student's t-test was used to determine intergroup differences.The findings suggest improvements in the laser group in comparison with the sham group with regard to mandibular dynamics, a reduction in postoperative facial swelling, a reduction in pain, and an increase in bite force.

Abstract: A 15-month-old male was admitted to hospital with a facial swelling of unknown origin which was of rapid onset over three hours, resulting in airway occlusion and septic shock. Ultimately, the swelling was found to be of odontogenic origin and was managed with high dose intra-venous antibiotics. Cellulitis of the face can be life-threatening and it is important to be aware of the clinical signs and ensure that the patient receives appropriate care to prevent deterioration. CPD/Clinical Relevance: It is essential for dentists in primary and secondary care to recognize and understand how to manage or refer a patient with facial cellulitis, and also for medical teams to seek prompt dental input in cases of facial swelling with a possible dental cause.

Ameloblastoma is a benign odontogenic tumor characterized by slow growth causing painless facial swelling. The tumor can behave locally aggressively, and may have direct destructive effects on the surrounding soft and hard tissues. This paper reports the unique case of a female patient with giant ameloblastoma of the mandible. Computed tomography (CT) revealed an enormous swelling of the left side of the face, resorption of the affected hemi-mandible, left maxilla, and tissues of the temporal, infratemporal, and pterygopalatine fossae. Pressure from the tumor resulted in displacement and destruction of the facial skeleton, upper aero-digestive tract structures, and some structures of the neck. The patient was treated by radical hemimandibulectomy with removal of the tumorous mass. Precise knowledge of the anatomical structures, and their locations and topographical relationships is required in the diagnosis and treatment plan for each surgical procedure in cases of giant ameloblastoma. CT imaging can be used to determine the extent and exact location of the lesion, revealing other important details that may help in selecting appropriate treatment.

Hereby, we report a case of a 75-year-old man who presented with a 3-day history of facial swelling and choking sensation. The only history of note was an insect bite on the left parotid gland area 3 days prior. The patient was later diagnosed with insect-bite-induced Ludwig’s angina. Enterococcus faecalis was detected on blood cultures and was presumed the source of infection. Intravenous antibiotics and corticosteroids were initiated. The patient was intubated and was subsequently made to undergo a tracheostomy insertion to establish a definitive airway. He was admitted to the intensive care unit and when his condition improved, he was transferred to the ward for full recovery. The patient spent a total of 66 days in hospital before being discharged. This case suggests that Ludwig’s angina can be caused by insect bites. However, further similar cases are needed to be documented to explore this theory.

Background Immunoglobulin E–mediated food allergy (FA) affects children and adults with variable age of onset. Phenotype and quality of life (QoL) differences between childhood-onset FA (COFA) and adult-onset FA (AOFA) are not known. Objective To identify phenotypic and QoL differences between AOFA and COFA. Methods A cross-sectional study of adults (≥18 years old) seen at Northwestern Memorial HealthCare clinics between 2002 and 2017 with an International Classification of Diseases ninth and tenth revision diagnosis of FA. Subjects completed a FA history survey and a FA QoL questionnaire. FA characteristics and QoL scores were compared between groups. Results Among 294 consented subjects, 202 had a clinical history consistent with labeled immunoglobulin E–mediated FA. The onset of FA symptoms occurred before age 18 years (COFA) in 80 subjects and after age 18 years in 122 (AOFA) subjects. Shellfish reactions were most common in AOFA-labeled subjects (28%), whereas tree nut reactions were the most common in COFA-labeled subjects (55%) compared with other triggers. Hives (68% vs 52%, P = .03), facial swelling (69% vs 50%, P = .009), wheezing (56% vs 29%, P Conclusion There are differences in specific food triggers and symptoms in adult-onset and childhood-onset labeled FA. Adults labeled with childhood-onset FA have reduced QoL.

Dupilumab is a relatively new and quite effective medication for recalcitrant atopic dermatitis in patients over 6 years of age. Here, we present a 12-year-old girl with progressively worsening episodic facial swelling and erythema while treated with dupilumab. This case highlights the possibility of angioedema as an adverse effect of dupilumab treatment.

A 4-year-old boy presented with a lifelong history of nasal obstruction, mouth breathing and snoring. His parents denied any associated rhinorrhoea, sneezing, facial pain, facial swelling, epistaxis, epiphora or sinus infections. Skin prick testing was negative for all environmental allergens. On

Partial hemifacial hyperplasia is a rare congenital malformation characterized by prominent unilateral overdevelopment of some of the hard and soft tissues of the face. This uncommon diagnosis should be considered while examining facial asymmetry. We report a case of slowly enlarging right facial swelling which turned out to be enlarged zygomtic arch. Complete evaluation led us to believe continued condylar hyperactivity as the underlying reason for worsening deformity. We offer an explanation for the same. Minimal surgical intervention led to significant aesthetic improvement which was patients main concern.

Parosteal osteosarcoma is a rare, slow-growing tumor most commonly arising from the surface of long bones. Tissue or histological sections from 5 dogs and 1 cat with zygomatic arch masses were examined. Clinical presentations varied from chronic sneezing to facial swelling. Imaging consistently demonstrated osseous proliferation in the area of the zygomatic arch. Histologically, the masses were characterized by well-differentiated fibro-osseous and chondroid components that radiated outward from the periosteum of the zygomatic bone. Cellular atypia and mitotic figures were uncommon. Parosteal osteosarcomas have previously been reported in the skulls of dogs and cats, but only 1 has been reported on the zygomatic arch. Initially, these tumors are of low histologic low grade, but with time, they can show more aggressive behavior and invade the underlying bone.

Melkersson-Rosenthal Syndrome (MRS) is a rare disease characterized by the triad of recurring facial paralysis, a fissured tongue, and recurring swelling of the lips and/or face. The etiology is unknown; it may be caused by hereditary factors or conditions occurring later in life. Observation of all 3 of the classic manifestations is rare; most often the symptoms are seen alone or in a pair, and they may appear at any stage of life. This report is the description of the case of a 51-year-old woman who was diagnosed with MRS based on her history and clinical features.

There are few reports describing suture periostitis (SP) in horses. This case series outlines the clinical, radiographic and histologic features of SP and compares various types of treatment in 15 horses presented to the Equine Clinic, Vetsuisse-Faculty, University of Zurich. Overall, the incidence of horses with SP presented to our clinic was low, and clinical signs were similar to those previously reported. Radiography was used to diagnose SP, but computed tomography was the imaging modality of choice for determining the extent of the bony changes and the suture lines affected. Horses that underwent surgical stabilization had more rapid resolution of signs than those treated conservatively or not treated at all.

A young lady presented with painful swelling, erythema, and tender nodules at the sites of previously injected filler. The given history, along with the clinical presentation and the distinctive histology of the lesion, confirmed the suspected diagnosis.

Pediatric head and neck lymphedema is rare and there have not been any reported cases in children. Here we discuss severe, diffuse head and neck lymphedema in a child caused by compression of the internal jugular veins by lymphadenopathy from Kawasaki's disease. With steroid and intravenous immunoglobulin treatment, the lymphadenopathy improved and facial edema slowly resolved. In review of the literature, complications of head and neck lymphedema including airway obstruction and blindness are discussed. This case highlights the importance of the pediatric otolaryngologist considering lymphedema as a cause for facial swelling and monitoring for complications of lymphedema.

Background Cutaneous lymphomas (primary and secondary lymphomas involving the skin) are a heterogeneous group with various clinical manifestations, histological features, and prognoses. Methods We describe eight cases of cutaneous lymphoma presenting with facial swelling. Results Our case series included three cases of primary cutaneous extranodal natural killer/T-cell lymphoma, one case of secondary cutaneous extranodal natural killer/T-cell lymphoma, one case of subcutaneous panniculitis-like T-cell lymphoma, one case of cutaneous CD4+ small/medium pleomorphic T-cell lymphoma, and two cases of peripheral T-cell lymphoma (unspecified). Conclusions This collection of cases and literature review emphasizes the need for clinical suspicion of cutaneous lymphoma in the differential diagnosis of patients with refractory facial swelling.

A 64-year-old Caucasian woman presented to the emergency department with a 6-day history of dental pain and significant right-sided facial swelling. She had seen her general practitioner twice in the previous days and was prescribed oral metronidazole. There was a history of asthma, epilepsy and

Nodular fasciitis (NF) is a benign reactive fibroblastic process which belongs to pseudosarcomatous proliferative lesions of soft tissues. Its occurrence is uncommon in the pediatrics with only a handful of cases reported in the sino-nasal area. We report a 14-month old boy, presented with right facial swelling caused by a 5 cm tumor involving the sino-nasal area with erosion of the floor of the orbit and extension into the pterygopalatine fossa. The lesion was completely excised through a midfacial degloving approach. Histological examination revealed the diganosis of NF. The postoperative period was uneventful with no evidence of recurrence 24-months postoperatively.