Facial swelling

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 01.08.2022

Definition
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Polyätiologic, acute or chronic, diffuse or localized, red or skin-colored, painful or painless swelling of the face with or without general symptoms (e.g. fever or internal diseases).

Classification
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Differential diagnostic considerations can be organized according to the following algorithm:
- localization of the swelling (e.g. eyelid, cheek, lip, forehead)
- Type of swelling:
  - localized
  - diffuse (evenly distributed).
- Acuity:
  - acute = < 6 weeks
  - chronic = > 6 weeks.
- Color:
  - red
  - non-red.
- Painfulness:
  - yes
  - no.
- General symptoms:
  - e.g. fever, swelling of lymph nodes.
- e.g. acute or chronic internal diseases.
Clinical disease states or symptoms:
- Diffuse, acute, red, facial swelling.
- Erysipelas
- Initial zoster
- Initial or concomitant phenomenon in infectious exanthema (e.g., viral exanthema (see below Exanthem (DD)
- Diagnostic symptom in erythema infectiosum (ear slap face)
- Angioedema
- Hereditary angioedema
- Diffuse, acute and/or chronic facial swelling in dermatomyositis or systemic scleroderma
- Urticaria (acute)
- Erythrophobia (erythema e pudore)
- Flushing phenomena
- Contact allergic or toxic eczema of the face (also collateral in acute eczema of the capillitium e.g. after dyeing the hair or after excessive UV exposure of the face).
Diffuse, chronic, red, facial swelling:
- Rosacea erythematosa
- Rosacea fulminans
- Acne conglobata
- Acne fulminans
- Cutaneous hemangioma of the infant (swelling depending on location; e.g. cheek, lip, eyelid)
Diffuse, acute and/or chronic facial swelling:
- Dermatomyositis
- systemic scleroderma
- Erythema perstans faciei
- M. Morbihan
- Urticaria (chronic)
- Edema in chronic alcoholism (see below alcohol, skin lesions and facies ethylica)
- Melkersson-Rosenthal syndrome.
Diffuse, acute/chronic, non-red, facial swelling:
- Subcutaneous hemangioma of infant (swelling depending on location; e.g., cheek, lip, eyelid).
- Facial edema in nephritis and nephrosis (see also Kidney Diseases, Skin Changes).
- Facial edema in chronic terminal renal failure
- Facial edema in thyroid dysfunction
- Plaque-like cutaneous mucinosis (see below [ Mucinosis(s)])
- Facial edema in influence congestion
- Facies lunata as a symptom of Cushing's syndrome
- Hunger edema
- Pseudoedema in facial paresis
- (Post-)traumatic edema (persistent swelling after severe facial trauma)
- Postoperative facial edema (persistent collateral swelling of the face after major facial flap plastic surgery).
"fat cheek" (acute/chronic):
- Swelling of the parotid gland of various etiologies (DD: diseases of the parotid gland).
- Acute apical periodontitis (common in an avital tooth).
- Dentitio difficile (difficult eruption of a wisdom tooth)
- Root granulomas with fistula formation
- Chronic osteomyelitis
- Parulis
- Emphysema (e.g. after dental treatment, e.g. due to dry blowing of a reamed root canal)
- Fistula formations after lymph node tuberculosis
- Actinomycosis (type of cervico-facial actinomycosis).
Lip swelling (acute/chronic):
- Collateral lip swelling due to aphthae of different etiology
- Herpes simplex labialis (see below Herpes simplex recidivans)
- Furuncle of the lip
- Cheilitis granulomatosa
- Ascher syndrome
- Chronic cheilitis glandularis
- Tapir snout
- Carcinoma, carcinoma of the lip.

Therapy
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Detection and elimination of the cause, if necessary careful internal or allergological clarification.
In case of morning swellings: cooling compresses, e.g. compresses soaked with black tea. Cool packs" are possible as an alternative.
For the therapy of eyelid swellings see there.