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Updated 03 September 2015

What's your diagnosis? – Case 26: swelling of face

Mrs D, a 55 year old businesswoman, is bothered by a sudden swelling of the right side of her face. See if you can figure out what's wrong.

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Mrs D consults her doctor with a sudden swelling of the right side of her face. She went to bed the night before with no hint of a problem, but when she woke up, she noticed the swelling. She can't recall any injury.

The swelling is mostly over the front part of her jaw towards her nose. Her right eye is almost completely swollen shut.

She has had no recent surgery and takes no chronic medicine. She does smoke. 

On examination, the GP found the following:

- Swelling over the right side of the cheek extending towards and alongside the nose. The swelling is slightly tender. 

- The patient has no loss of sensation, and except for the fact that the swelling makes movement of the facial muscles more difficult, it does not appear as if she has facial weakness.

Ears: slightly red tympanic membrane

Nose: normal

Throat: post nasal drip, no masses or swelling

Mouth: suspicious-looking right upper molar tooth.

The neurological examination is normal. All other systems are found to be normal on examination.

Her vital signs are as follows:

Temperature: 38,1

Pulse: 91

Blood pressure: 138/85

Based on the above, what is the most likely diagnosis, and what would be the appropriate management approach?

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis? -  Case 1: vomiting and weight loss

What's your diagnosis? -  Case 2: eye pain

What's your diagnosis? -  Case 3: strange behaviour and a bullet in the back

What's your diagnosis? -  Case 4: seeing odd things

What's your diagnosis? - Case 5: mysterious lungs

What's your diagnosis? - Case 6: runner with seizures

What's your diagnosis? - Case 7: swollen knee

What's your diagnosis? - Case 8: bloody semen

What's your diagnosis? - Case 9: confusing neurological signs

What's your diagnosis? - Case 10: diabetic teenager with unusual signs and symptoms

What's your diagnosis? - Case 11: bruising with no apparent reason

What's your diagnosis? - Case 12: severe tummy pain

What's your diagnosis? - Case 13: severe sore throat

What's your diagnosis? - Case 14: abdominal pain and swelling

What's your diagnosis? - Case 15: the world is spinning

What's your diagnosis? - Case 16: numbness in forearm

What's your diagnosis? - Case 17: burning urine

What's your diagnosis? - Case 18: boy with persistent fever

What's your diagnosis? – Case 19: lady who can't lose weight

What's your diagnosis? – Case 20: chest pain next to breastbone

What's your diagnosis? – Case 21: burning sensation in vagina

What's your diagnosis? – Case 22: vomiting and headaches

What's your diagnosis? – Case 23: frequent urination

What's your diagnosis? – Case 24: painful and swollen leg

What's your diagnosis? – Case 25: swollen knee and fever

 
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