Sara N. Aldosary
Payam Mirfendereski
Thomas P. Sollecito
Takako I. Tanaka
Roopali Kulkarni
Eric T. Stoopler
| Sara N. Aldosary | Payam Mirfendereski | Thomas P. Sollecito | Takako I. Tanaka | Roopali Kulkarni | Eric T. Stoopler |
Sara N. Aldosary1,2, Payam Mirfendereski2, Thomas P. Sollecito2, Takako I. Tanaka2, Roopali Kulkarni2, Eric T. Stoopler2
1Oral and Maxillofacial Surgery, University of Pennsylvania Dental Medicine; 2Oral Medicine, University of Pennsylvania Dental Medicine
Introduction
Facial swelling may be attributed to several etiologies, including infections, inflammatory diseases and/or neoplasms. Patients with acute onset of symptoms will often seek care in the urgent/emergent setting. Delay in appropriate and timely care of acute facial swelling can lead to serious complications, such as disseminated infection and/or airway compromise.
Methods
N/A
Results
Case summary A 68-year-old female complained of symptomatic left facial swelling accompanied by low-grade fever for one week after eating a hard potato. She reported constant throbbing pain and mild numbness in the left face which interfered with diet and sleep. The patient reported symptoms were exacerbated with mouth opening, chewing and touching the affected area with no relieving factors. She was previously evaluated in an Emergency Department (ED) four days prior to presentation, diagnosed with left side facial swelling/adenopathy and managed with methylprednisolone, cyclobenzaprine and oxycodone-acetaminophen without benefit. Medical history was significant for hypertension, Meniere's disease of left ear and anxiety. Medications included triamterene-hydrochlorothiazide, quetiapine and lorazepam. Family and social histories were non-contributory and review of systems was negative. Extraoral examination significant left facial asymmetry with left panfacial erythema and tenderness in the left periauricular area, masseter, and area of parotid overlying the mandibular ramus with cranial nerves V and VII grossly intact. Maximum interincisal opening was 15 mm with difficulty performing lateral mandibular excursions. Intraoral examination revealed milky discharge of left Stenson’s duct. Panoramic radiograph was unremarkable. Diagnosis was consistent with left facial swelling of infectious etiology and given the acute onset of symptoms, progressive nature and clinical appearance, the patient was referred to the ED for further management. The patient was evaluated by a physician assistant in the ED and subsequently by Otorhinolaryngology who admitted her for management. Laboratory analysis revealed a white blood count of 26,000/uL. Methicillin-Resistant Staphylococcus aureus (MRSA) was not detected by culture. Maxillofacial Computed Tomography findings did not reveal abscess or sialolith and diagnosis was consistent with acute bacterial parotitis, The patient was managed with IV vancomycin and ampicillin and discharged after two days on oral amoxicillin/clavulanate with significant resolution of facial swelling.
Conclusion
Acute bacterial parotitis is an uncommon cause of acute facial swelling which may necessitate multidisciplinary management.