IMG_1420.jpg
What happened to this patient
analyse_media
This middle-aged woman shows unilateral left-sided facial swelling with the following findings:
Clinical Findings
Left mid-face swelling and erythema
- Diffuse edema involving the left cheek and infraorbital (below-eye) region
- Mild narrowing of the left eye opening due to the swelling extending upward
- Localized redness/erythema directly beneath the left lower eyelid
- Noticeable facial asymmetry compared to the right side
Incidental findings
- Two melanocytic naevi (moles) - one on the nose bridge, one on the left cheek
- Mild bilateral malar hyperpigmentation (possibly melasma)
- Nose stud piercing
Most Likely Diagnoses
| Possibility | Why it fits |
|---|---|
| Odontogenic (dental) abscess | Most common cause of left unilateral mid-face swelling - infection from upper left molar/premolar spreads into the buccal or canine space |
| Facial cellulitis | Bacterial infection of subcutaneous tissue causing warm, tender, red swelling |
| Maxillary sinusitis | Left maxillary sinus infection can present with infraorbital swelling and erythema |
| Dacryocystitis | Tear duct infection, though typically more medial/near the inner eye corner |
| Insect bite / allergic reaction | Can cause rapid unilateral swelling, though usually without this degree of erythema |
What to Do
Given the combination of unilateral swelling + erythema in the mid-face, odontogenic infection (dental abscess spreading to the buccal/canine space) is the top concern. This can escalate to Ludwig's angina or orbital cellulitis if untreated.
Urgent evaluation recommended:
- Dental/oral examination (percussion test of upper left teeth)
- Palpation for fluctuance (abscess vs. diffuse cellulitis)
- Panoramic dental X-ray or CT face/neck if deep space infection is suspected
- If bacterial cellulitis/abscess: antibiotics (amoxicillin-clavulanate or clindamycin) +/- incision and drainage
This patient should be seen by a dentist or oral-maxillofacial surgeon promptly.
This is a shared conversation. Sign in to Orris to start your own chat.