Facial Infections
Infections of the jaws and facial bones can come from a variety of sources. The most common cause is abscess of the teeth. Infection follows the path of least resistance, so the location of facial swelling varies, depending on which tooth is infected. Everyone responds differently to having an infection. Some patients are able to contain the infection and keep it under control. In other patients, the infection may spread and cause fever, swelling, sore throat, and a generally ill feeing. It is important to seek consultation whenever an area of pain exists in the mouth, so that serious complications do not develop. Do not ignore the important signs of pain and fever, as they usually signal the presence of a significant infection.
Most infections are treated by antibiotic medications, and most importantly, by removal of the source of the infection. Warm salt water rinses and warm compresses are also helpful to increase blood flow to the area. Serious infections require surgical drainage of the area of abscess, known as an "incision and drainage" procedure.
Usually, an infection of a lower jaw tooth will lead to swelling on the lower jaw. A small infection like this can cause an abscess that can spread down the throat, and go as far as the sac around the heart.
Infections of the upper teeth usually spread to the cheek and the area under the eye. Some of the veins in this area do not have valves, so blood can flow backward and spread infection to an area under the brain, known as the cavernous sinus. Notice the swelling of the lower eyelid in this patient.
This patient had a very severe infection. Notice both the upper and lower eyelids are red and swollen, in addition to the cheek. He required admission to the hospital for many days of intravenous antibiotics. This was caused by a single abscessed tooth. An incision and drainage (I & D) was performed to release the pus and pressure, which was spreading rapidly. A rubber drain was placed into the area to allow for continued drainage of the infection. Drains may be left in place for 1 to 5 days or more, depending on the severity of the infection.
This woman was referred by her dermatologist because of an area on her skin that was continually draining pus. It was originally treated as a superficial skin abscess, but failed to respond to antibiotics. With thorough questioning, she disclosed that she had a cosmetic chin implant placed by a plastic surgeon many years previously. She commented that her chin had become less prominent over the past year.
On examination, she was tender over the right side of her chin. An x-ray of the area showed a cyst-like area on her lower jaw. The chin implant had eroded into her lower jaw, and become infected. The lesion on the skin was a "fistulous tract" from the implant to the skin. She was treated by removal of the chin implant from an incision inside her mouth. Then, from the outside, the fistulous tract and involved skin were excised, the underlying muscles were closed, and the skin was repaired.
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