Makindo Medical Notes

😮 Facial swelling is a common presentation in both GP and A&E. It may arise from benign local causes (e.g., dental abscess) or be the first sign of a life-threatening emergency (e.g., anaphylaxis, SVC syndrome, orbital cellulitis). 👉 Always distinguish unilateral vs bilateral, local vs systemic, and look for red flags 🚨.

🩺 General Considerations

• Facial swelling may be due to infection, allergy, trauma, systemic disease, or autoimmune causes. Clinical context is key.
• Unilateral swelling 🤔: Suggests localised pathology (trauma, cellulitis, dental abscess).
• Bilateral swelling 🟰: More often systemic (allergy, nephrotic syndrome, hypothyroidism, autoimmune disease).
• Periorbital swelling 👁: May be local (conjunctivitis, sinusitis, trauma) or systemic (thyroid disease, nephrotic syndrome).
• Associated symptoms: Fever, pain, itching, erythema, vision change, dyspnoea — guide urgency & cause.

🧾 Potential Causes

🚩 Red Flags

• ⚡ Sudden severe swelling + dyspnoea → anaphylaxis → IM adrenaline.
• 👁 Eye pain, ↓ vision, proptosis → orbital cellulitis / cavernous sinus thrombosis → emergency.
• 🌡 Fever + malaise → infectious cause (cellulitis, sinusitis).
• 🙂 Facial paralysis/weakness → consider Bell’s palsy, stroke, or tumour.
• 📈 Persistent/progressive swelling → systemic disease or malignancy.
• 🫁 SVC syndrome → face/neck swelling + distended veins → urgent oncology input.