Facial Bone Asymmetry in Children: Allergies or Fibrous Dysplasia? - Otolaryngology

More Info

---

Facial bone asymmetry in children can be a concerning issue for parents, especially when accompanied by symptoms such as swelling or tenderness. In your case, the child has a history of allergies and recurrent sialadenitis (inflammation of the salivary glands), which can complicate the diagnostic picture.
The swelling around the left eye and the prominence of the left zygomatic bone (cheekbone) could indeed be related to several factors. Allergies can cause localized swelling due to inflammation, and if the child has had a recent allergic reaction, this could explain the asymmetry. Allergic reactions can lead to conditions such as allergic conjunctivitis, which may cause swelling around the eyes.
However, the mention of "fibrous dysplasia" by the physician is significant. Fibrous dysplasia is a bone disorder where normal bone is replaced with fibrous tissue, leading to structural weakness and deformity. It can affect any bone in the body, including the facial bones. In children, fibrous dysplasia can present as asymmetry in the facial structure, and it may be associated with pain or tenderness in the affected area.
The fact that the swelling has improved with anti-inflammatory medication suggests that there may be an inflammatory component to the child's condition. However, the persistence of the asymmetry raises the possibility of an underlying structural issue, such as fibrous dysplasia or another bone lesion.
In terms of differential diagnosis, it is also important to consider other conditions that could cause facial asymmetry. For instance, sinusitis (inflammation of the sinuses) can lead to swelling in the facial region, particularly around the cheeks and eyes. If the child has a history of recurrent sinus infections, this could be a contributing factor. Additionally, trauma or injury to the facial bones could lead to localized swelling and asymmetry.

Given the complexity of the situation, it is advisable to follow through with the recommended imaging studies, such as a CT scan, to obtain a clearer picture of the underlying structures. This will help differentiate between an inflammatory process and a potential bony lesion like fibrous dysplasia.
In summary, while allergies and sinusitis could explain some of the symptoms, the possibility of fibrous dysplasia or another bony abnormality cannot be ruled out without further investigation. It is essential to consult with a pediatric specialist, such as a pediatric otolaryngologist or a pediatric orthopedic surgeon, who can provide a comprehensive evaluation and guide the next steps in management. Early diagnosis and intervention are crucial in managing any potential underlying conditions effectively.