Right-sided Facial Swelling Research Articles

Diagnostic Imaging in Veterinary Dental Practice

) was evaluated because of right-sided facial swelling and a recent history of dysphagia and stridor. The squirrel was anesthetized to allow for phys-ical examination and collection of blood samples. Physical examination revealed a fracture of the maxillary right third premolar tooth and an associated abscess. Results of hematologic and serum biochemical testing were with-in reference limits for this species. While the squirrel was anesthetized, radiographs of the skull were obtained

Imaging Findings of “Anesthesia Mumps” (Acute Postoperative Sialadenitis) After General Anesthesia

We present a rare case of acute postoperative sialadenitis or "anesthesia mumps" necessitating emergent intubation in a 16-year-old girl after biopsy of a brainstem mass under general anesthesia. Postoperative computed tomography of the brain demonstrated extensive right-sided facial swelling, parotid gland enlargement, and pharyngeal edema extending to the parapharyngeal space, soft palate, and uvula with significant narrowing of the airway. To our knowledge, this entity has not been previously described in the radiologic literature.

Case Report: Odontogenic Cyst

Right facial swelling in 10-year-old boy.A10-year-old boy with no past medical or surgical history presents to the emergency department, accompanied by his mother, complaining of right-sided facial swelling for the past two months. The mother reports that he was enrolled in a beginner boxing class, and was punched in the face with a soft glove two months prior to presentation. Since he was struck, she has noticed a progressive swelling to the right side of his face. The patient denied any change in speech, pain with chewing, difficulty swallowing, or sensitivity to cold or hot foods and liquids, and he had no history of fever, chills, dental pain, or recent dental work performed. The child had been seen by his pediatrician multiple times over the few weeks prior to ED presentation, and was initially treated for a hematoma. The swelling did not improve with conservative measures, and the child was eventually referred to see a surgeon, but the mother was unable to obtain an appointment with one.Right mandibular mass in the sagittal and coronal planes.His vital signs were normal, and his physical exam demonstrated a well appearing, well developed boy in no distress. Examination of his face revealed marked swelling over the right cheek without any discernible border, erythema, warmth, or tenderness. The mouth revealed deviation of the first and second molars with increased spacing between the two teeth. No erosions, abscesses, drooling, bleeding gums, or malocclusion were present. Basic laboratory studies included a complete blood count, electrolytes, renal function, and coagulation profile, which were all within normal limits. A contrast enhanced facial bone CT scan was obtained, and revealed an expansile, septated hypo-attenuated mass measuring approximately 9.2 × 4.7 × 5.1 cm in craniocaudal, transverse, and anterior-posterior dimensions, respectively, centered around the right mandible and mildly displacing surrounding structures. Results of the CT and blood work were explained to the patient and his mother, and the patient was discharged to follow up with a pediatric plastic surgeon with subspecialty in craniofacial procedures. Odontogenic cyst is a broad term describing a variety of cysts defined as epithelial-lined structures derived from odontogenic epithelium. Odontogenic cysts can be divided into inflammatory and developmental categories. Inflammatory cysts include radicular (periapical) and paradental. Developmental cysts include dentigerous (follicular), developmental lateral periodontal, odontogenic keratocyst, and glandular odontogenic cyst. Included in the differential of the mandibular mass of this patient are traumatic bone cyst, central giant cell granuloma, and the malignant tumors that affect the area described. (Laryngoscope 1998;108[2]:280.) Most odontogenic cysts are defined more by their location than by any histologic characteristics, and the surgeon must provide the pathologist with appropriate history and radiographs when submitting such specimens for examination. The most important concept in managing odontogenic pathology is obtaining a complete history and thorough physical examination, which should include careful inspection, palpation, and percussion of the affected part of the jaw and overlying dentition. Radiologic examination is usually the first procedure of choice in evaluating jaw-related cysts and tumors. In general, well-demarcated lesions outlined by sclerotic borders suggest benign growth while aggressive lesions tend to be ill-defined lytic lesions with possible root resorption. Finally, fine-needle aspiration, open biopsy, or excisional biopsy may be necessary for definitive diagnosis, which is needed to determine appropriate medical or surgical therapy. (J Dent Child [Chic] 2009; 6[3]:217.)Dental displacement noted in bone windows.This patient's cyst is significant for the growth rate and large size at presentation to the ED. Because panorex radiography is difficult to interpret and rarely available to the emergency physician, contrast-enhanced CT scan is the most appropriate diagnostic modality for evaluation of facial masses. Patient follow-up is of utmost importance because odontogenic masses are often deforming, may be malignant, and may sometimes require extended treatment. Drs. Bair, Decena, Ruotolo, andHenesch, andMs. Millerare from the department of emergency medicine at Good Samaritan Hospital Medical Center in West Islip, NY.

Ludwig’s angina

Patients with Ludwig’s angina require urgent evaluation for airway obstruction due to elevation and posterior displacement of the tongue. Emergency physicians should remember that risks of laryngospasm preclude blind oral or nasotracheal intubation. A 54-year-old female presented to the emergency department (ED) with right-sided facial pain, subjective fever, and chills for 1 week. Physical examination revealed right-sided facial swelling, trismus, tongue elevation (Fig. 1), submandibular and sublingual swelling, and tenderness with adenopathy. Computed tomography (CT) findings were (Fig. 2) consistent with Ludwig’s angina. The patient was treated with dexamethasone and clindamycin, and taken for surgical decompression and tooth extraction then discharged home. Pathological analysis showed polymicrobial flora including Staphylococcus aureus, Eikenella corrodens, Clostridium clostridiforme, and Prevotella buccae. Fig. 1 Clinical appearance Fig. 2 Computed tomography findings Ludwig’s angina, a rapidly progressive cellulitis of the floor of the mouth, involves the submandibular, submaxillary, and sublingual spaces. Patients have swelling, pain, and elevation of the tongue, malaise, fever, neck swelling, and dysphagia. The submandibular area can be indurated, sometimes with palpable crepitus. Inability to swallow saliva and stridor raise concern because of imminent airway compromise. The most feared complication is airway obstruction due to elevation and posterior displacement of the tongue. The mortality rate for Ludwig’s angina is currently below 8% down from the preantibiotic numbers over 50% [1]. Nasal fiberoptic evaluation should be performed with imminent airway obstruction. Securing the airway by blind oral or nasotracheal intubation is contraindicated because of the risk of laryngospasm. Diagnostic sensitivity of clinical examination alone is 55%. In less urgent cases, contrast-enhanced CT may increase this to 95% [2]. Immunocompetent patients should receive ampicillin-sulbactam, with clindamycin reserved for penicillin-allergic patients. Immunocompromised patients require empiric broad-spectrum antibiotics. Any source of infection should be removed. Needle drainage can be performed to reduce the risk of spreading infection [3].

Expansile Mass of the Maxilla

A 34-year-old white woman presented at the University at Buffalo Oral and Maxillofacial Surgery Service (Buffalo, NY) in October 2006 with a chief complaint of right-sided facial swelling. The patient was uncertain of its duration, but reported a vague sensation of nasal pressure on the affected side.

A Mass in the Temporomandibular Joint

A 55-year-old woman with a three-year history of progressive migraine headaches developed a rightsided posterior open bite and right preauricular facial swelling. Several primary and specialty medical and dental practitioners evaluated her case and made a diagnosis of intractable migraine headaches. Because of her progressive symptoms, she had been referred to the Division of Oral and Maxillofacial Surgery, Mayo Clinic (Rochester, Minn.), for further evaluation. The patient’s medical and surgical histories were unremarkable, including any history of facial trauma. Her facial pain and migraines had been treated with a range of overthe-counter and prescription analgesics, with limited success. At examination, the patient had a mild degree of right-sided preauricular facial swelling that was mildly painful to palpation and was associated with a malocclusion of approximately 3 millimeters on the right side and a posterior open bite with continued and progressive ipsilateral headaches. Panoramic plain radiography showed a spaceoccupying lesion in the right temporomandibular joint (TMJ) (Figure 1). A computed tomographic scan with intravenous contrast material disclosed a hypoattenuated mass occupying the right TMJ space, with cortical erosion and destruction of the glenoid fossa (Figure 2). The cortical architecture of the temporomandibular condyle was well-preserved, although it was displaced significantly and inferiorly, leading to the development of malocclusion. Cranial nerves were grossly intact, with no evidence of neurologic deficit in the trigeminal or facial nerve distributions. There was no evidence of involvement of the middle ear canal, and hearing was preserved. In the absence of a histologic diagnosis, the treating surgeon (D.K.) performed a right TMJ arthroplasty for open joint exposure and exploration. Upon entry into the TMJ space, the surgeon noted a large volume of cartilaginous foreign bodies in the intra-articular joint space. The articular surface of the mandibular condyle appeared to be wellpreserved; however, there was significant erosion and disruption of the glenoid fossa superiorly, with a small focus of intracranial extension. Despite a limited dural exposure, there was no significant cranial extension or cerebrospinal fluid leak. After removing the tumor, the surgeon repositioned the mandibular condyle within the glenoid fossa, resulting in improved occlusion. A mass in the temporomandibular joint

Dedifferentiated chondrosarcoma of the maxilla

A 20-year-old male reported with right-sided facial swelling, epistaxis and right sided proptosis of two months duration. Computerized tomography scan of the face revealed a mass in the right maxillary sinus. The patient underwent surgery and the postoperative histopathology was suggestive of dedifferentiated chondrosarcoma. The present report discusses this rare presentation and the issues in its management.

Down in the mumps

A 10-week-old female infant presented with a right-sided facial swelling without any constitutional symptoms. The swelling was nontender, nonfluctuant, with no erythema or induration. On the basis of the clinical picture, magnetic resonance imaging findings and serology, a diagnosis of unilateral mumps parotitis was made. The United Kingdom is currently experiencing a mumps epidemic with a 28-fold rise in the number of cases over the last 10 years. Infants are being increasingly affected. Mumps parotitis, which was previously unreported in infants, needs to be considered as part of the differential diagnosis when a small child presents with swelling of the parotid gland.

Diagnostic Imaging in Veterinary Dental Practice

) was evaluated because of right-sided facial swelling and a recent history of dysphagia and stridor. The squirrel was anesthetized to allow for phys-ical examination and collection of blood samples. Physical examination revealed a fracture of the maxillary right third premolar tooth and an associated abscess. Results of hematologic and serum biochemical testing were with-in reference limits for this species. While the squirrel was anesthetized, radiographs of the skull were obtained

Multiple unilateral maxillary dentigerous cysts in a non-syndromic patient: A case report and review of the literature

Summary Dentigerous cysts are the most common developmental odontogenic cysts of the jaw, arising from impacted, embedded or unerupted teeth. Although mostly solitary, multiple cysts occur in association with syndromes such as mucopolysaccharidosis type VI, cleidocranial dysplasia, basal cell nevus syndrome, and Gardner's syndrome. Multiple cysts in non-syndromic patients are extremely rare, occurring almost exclusively in the mandible. We report the case of a four-year-old girl with painless right-sided facial swelling, diagnosed with two dentigerous cysts in the right maxillary sinus, who successfully underwent enucleation. To our knowledge this is the only case of multiple unilateral maxillary dentigerous cysts in a healthy, non-syndromic patient.

Ameloblastoma of the Mandible

A 28-year-old woman presented with a 9-month history of progressive right-sided facial swelling. A transoral incisional biopsy was performed at a community hospital and was suggestive of ameloblastoma. The patient subsequently presented to our center for further management. X-ray (A) and CT scan (B) demonstrated a multiloculated mass extending from the ascending ramus to the body of the mandible but not involving the temperomandibular joint. The extent of this mass was readily appreciated on 3-dimensional CT reconstruction (C). She underwent a right hemimandibulectomy with an immediate right fibular myosseous free flap microvascular reconstruction from a right leg donor site. Grossly the specimen showed a 6.0 2.0 3.5-cm mass involving the ramus of the right mandible. On sectioning, the mass had a multicystic appearance and histology was suggestive of an acanthomatous variant of ameloblastoma. The postoperative course was uneventful and the patient was discharged home on postoperative day 13. She was subsequently fitted with a partial lower denture and 20 months postoperatively she remains disease free and reports a good functional outcome. Ameloblastoma of the jaw is a rare odontogenic tumor. A review of 3,677 cases reported over 33 years in the world literature has been previously published. Ameloblastomas tend to present in young patients (average age 36 years) as a painless slow-growing mass in the molar region of the mandible. Radiographically they can be classified as unicystic or multicystic. Unicystic lesions have a higher recurrence rate than multicystic lesions. On histopathologic assessment one-third are plexiform variants, one-third are follicular variants, and one-third are other types. Follicular variants recur more commonly than plexiform variants. Surgery is the therapy of choice for these tumors and the role of chemotherapy or radiotherapy in disease management is limited. Vascularized fibular free flap microvascular reconstruction can offer these patients an excellent aesthetic and functional outcome.

Eye Injury After Jellyfish Sting in Temperate Australia

Although jellyfish stings are an uncommon medical problem in temperate Australia, significant morbidity can occur, particularly in association with infestations of large numbers of jellyfish in public swimming areas. We report a case of a jellyfish sting-related eye injury, probably caused by the "hair" jellyfish (Cyanea capillata) from southeast Australia. The patient, a 54-year-old man, was stung while swimming without goggles in a jellyfish-infested bay. He experienced severe pain in his right eye, requiring narcotic analgesia, and had decreased visual acuity associated with right-sided facial swelling. Although usually brief and self-limiting, eye injuries after jellyfish stings should be assessed and treated as early as possible to reduce the risk of longer term sequelae. Water safety campaigns should incorporate information on the prevention and early treatment of such stings.

Pathologic quiz case. A sinonasal mass in a 79-year-old African American woman.

79-year-old African American woman presented with a 3-week history of right-sided epistaxis, purulent rhinorrhea, and facial swelling. The patient also complained of a red bulging right eye with tearing. Her past medical history was significant for bilateral breast carcinomas treated with bilateral mastectomies (1986 and 1993) and adjuvant chemotherapy and radiotherapy. In addition, she had hypertension, obesity, diabetes mellitus, and asthma. She had smoked 2 packs per day (80 pack-years), but she had quit approximately 20 years earlier. An obvious nasal mass was noted upon examination. Magnetic resonance imaging of the sinuses demonstrated a large mass (indicated by asterisk in Figure 1) involving the right maxillary sinus and into the nasal cavity. The tumor extended to the right orbit and to the temporal and pterygoid fossae. The inframedial aspect of the right orbit and

Unilateral hypertrophy of the face associated with infiltrating lipomatosis

A 25-year-old African man presented with a right-sided facial swelling that had been present from birth and for which he had received no treatment (Fig 1). His medical history was unremarkable, with no family history of facial abnormalities. Clinical examination and computed tomography showed that the enlargement involved the soft and bony tissues of the lower half of the face, including the tongue, maxilla, and teeth. He underwent surgical debulking of the soft tissues, including a total parotidectomy and partial resection of the buccal fat pad and masseter. The zygoma and the orbital margins were reduced. Microscopic examination of the parotid showed infiltration of the glandular tissue by mature, benign adipocytes (Fig 2), a characteristic feature of the infiltrative lipomatoses. The surgery produced a significant improvement in his appearance (Fig 3) but resulted in a palsy of the zygomatic branch of the facial nerve, ptosis of the lower eyelid, and a hypertrophic scar in his neck. Further correction of the asymmetry was achieved by liposuction of 50 mL of buccal fat and a lateral tarsorraphy in May 1995. On examination in August 1995, there was still mild asymmetrykypertrophy of the right side of the face.

Necrotizing Fasciitis of the Head and Neck: Report of Three Cases

Necrotizing Fasciitis of the Head and Neck: Report of Three Cases

Mucormycosis in a Patient With Acquired Immunodeficiency Syndrome

Mucormycosis classically affects patients who are immunocompromised or debilitated, including those with diabetes, malignant neoplasm, renal failure, and neutropenia. 1 Despite the opportunistic nature of mucormycosis infection, there are few cases of cutaneous manifestations of the infection reported in patients with the acquired immunodeficiency syndrome (AIDS). 2-5 We describe a patient with AIDS, neutropenia, and iron overload who developed primary cutaneous mucormycosis. In addition, the patient had recently undergone intralesional chemotherapy and radiation treatments on his face for Kaposi sarcoma. Report of a Case. A 41-year-old white man with AIDS manifested by a CD4 cell count below 10×10 9 /L and a medical history that included disseminated Kaposi sarcoma, cytomegalovirus retinitis, recurrent herpes simplex infection, anemia, and adrenal insufficiency was admitted to the hospital with acute onset of right-sided facial pain and swelling. His facial Kaposi sarcoma had been treated previously with intralesional doxorubicin hydrochloride and radiation. On

Iodide mumps after intravenous urography.

SALIVARY-gland swelling is an infrequent manifestation of iodism or iodide idiosyncrasy, occurring after therapy with inorganic, iodine compounds. Its appearance may suggest the possibility of mumps or stone in the salivary ducts and lead to embarrassing, tedious and sometimes costly investigations. The following cases are reported because salivary-gland swelling occurred as a sequel to intravenous urography with new organic iodide preparations, diatrizoate sodium (Hypaque) and sodium methylglucamine diacetylamino-triiodobenzoates (Renografin), and introduced the diagnostic possibilities of epidemic parotitis and salivary-duct calculus. Case Reports Case 1. M.E., a 68-year-old merchant, complained of right-sided facial swelling and tenderness. He had recently had a . . .