Facial Swelling: Causes and When to Seek Medical Help

Swelling on the left side of the face?

This morning, when I woke up and yawned, I noticed that my left cheek felt very tight, and upon looking in the mirror, I saw that my left cheek was completely swollen.
I had previously sought medical attention in 2019-2020 due to severe pain near the opening of the left salivary gland, but after two visits to an ENT specialist and one to a dentist, no cause for the pain was identified.
During my first visit to a large hospital's ENT department, the doctor laughed and seemed surprised, asking who didn't have a salivary gland opening.
I understood that it was the salivary gland opening, but the issue was that it hurt a lot, yet the doctor didn't prescribe any medication.
On my second visit to a well-known ENT clinic, the doctor didn't say much and prescribed anti-inflammatory and pain relief medication.
While the pain eased somewhat, it never completely resolved.
After a lavish meal during the 2020 Lunar New Year, the pain flared up again, but due to the outbreak of the pandemic, I was hesitant to go back to the hospital.

I later discovered that whenever the left side hurt intensely, a large amount of warm saliva would suddenly be expelled, which I assumed was normal salivation.
I wouldn't typically feel saliva being secreted.
After the pandemic situation improved, I visited a nearby dentist, who suggested that it might be a salivary stone and that I would have to wait for it to resolve on its own.
He even laughed at me for feeling saliva being secreted.
I had been in pain for nine months, and it was frustrating to be laughed at.
Since the doctor said it would resolve itself, I had to learn to live with it, especially during the pandemic when I didn't want to seek medical help everywhere.
The pain never fully disappeared; it varied between mild and severe.
Sometimes, after eating, the pain would be particularly intense, but if I felt a warm rush of saliva, the pain would decrease for a few hours.

Now, my cheek is completely swollen, which really scares me because it's the same side where I previously experienced pain.
When I touch it, it feels slightly warmer than the right side.
Although it doesn't hurt as much as before, I can still feel swelling on the inside of my left cheek, and the exterior is visibly protruding.
With the current wave of the pandemic, I really don't want to go around seeking medical help like before.
What should I do? Should I go to the hospital for an examination? If so, which department should I visit? Or should I first check with a nearby clinic? Thank you for your response.

L, 40~49 year old female. Ask Date: 2021/05/17

Dr. Liao Yaopan reply Family Medicine

Hello, based on your description, it is still recommended to seek further evaluation from an otolaryngologist or a dentist.
Online consultations are not equivalent to in-person medical visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2021/05/17

More Info

Facial swelling can be a concerning symptom, especially when it appears suddenly or is accompanied by pain. Based on your description, it seems that you have a history of issues related to your left salivary gland, which may be contributing to your current symptoms. Let's break down the potential causes of your facial swelling and discuss when it is necessary to seek medical help.

Possible Causes of Facial Swelling
1. Salivary Gland Issues: Given your history of pain near the salivary gland and the sensation of excessive saliva production, it is possible that you are experiencing a blockage, such as a salivary stone (sialolithiasis). This can lead to swelling and pain, particularly when eating or drinking, as the gland attempts to produce saliva but is obstructed.

2. Infection: An infection of the salivary glands, known as sialadenitis, can cause swelling, pain, and sometimes fever. This condition often occurs when saliva flow is reduced, leading to bacterial growth.

3. Allergic Reactions: Allergies can cause localized swelling in the face, particularly if you have been exposed to allergens. This could be in the form of food, medications, or environmental factors.

4. Dental Issues: Problems with teeth or gums, such as an abscessed tooth, can also lead to facial swelling. If the swelling is near the jaw or cheek, it may be related to dental health.

5. Other Medical Conditions: Conditions such as angioedema (a type of swelling that can occur due to allergic reactions) or even systemic issues like kidney problems can lead to facial swelling.

When to Seek Medical Help
Given that you have experienced persistent pain and swelling on the same side of your face, it is advisable to seek medical attention. Here are some signs that indicate you should see a doctor:
- Persistent or Worsening Symptoms: If the swelling does not improve or worsens over time, it is important to get evaluated.

- Accompanied Symptoms: If you experience fever, chills, or severe pain, these could indicate an infection that requires treatment.

- Difficulty Breathing or Swallowing: If you have trouble breathing or swallowing, this is a medical emergency, and you should seek immediate help.

- Changes in Vision or Sensation: If you notice any changes in your vision or facial sensation, it is crucial to get evaluated promptly.

Which Specialist to See
For your specific symptoms, it would be best to consult an Ear, Nose, and Throat (ENT) specialist. They can evaluate your salivary glands, perform imaging studies if necessary (like an ultrasound or CT scan), and determine if there is a blockage or infection. If you suspect a dental issue, visiting a dentist may also be appropriate, especially if the swelling is localized around your teeth or gums.

Conclusion
In summary, while facial swelling can have various causes, your history of salivary gland pain suggests that it may be related to that area. Given the duration and nature of your symptoms, it is advisable to seek medical attention from an ENT specialist. They can provide a thorough examination and appropriate treatment options. Do not hesitate to seek help, especially if your symptoms change or worsen. Your health is important, and addressing these concerns early can lead to better outcomes.

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