Cellulitis conjures up images of ‘old ladies’ with swollen legs, inflamed, red and angry. For sure, the legs are a popular site for cellulitis and probably the most commonplace but this disorder can occur anywhere on the body. It is also frequently linked to a primary source of infection for which cellulitis is the secondary response.
What actually is facial cellulitis?
This is a bacterial infection affecting the dermis and subcutaneous layers of skin on the face and neck. The eyes – orbital cellulitis around the eye socket – nose and cheeks (buccal) are favoured areas for facial cellulitis.
Facial cellulitis has shown a decrease in recent decades but is still relatively prevalent amongst paediatrics with a strong correlation to dental issues and tooth abscesses. Determining what facial cellulitis invariably required medical investigation of an acute or chronic infection elsewhere.
Facial cellulitis of orthodontic origin
Facial cellulitis in minors or adults can signpost infection within the mouth of which the cellulitis is just one visible symptom. For any patient, the pain is usually the foremost driver to seek assistance; toothache is one of the most hideous and agonising of problems. In an infant with limited communication skills, parents may initially confuse it with teething which can rise to discomfort and red, flushed cheeks not immediately recognising it. If the swelling and inflammation are specific to pinpoint one location then the likely causes are oral. Diffuse facial cellulitis may not, therefore, originate from dental causation.
What are the dental treatments and remedies available with facial cellulitis?
If the patient is not significantly unwell, fever is absent and they are able to intake fluids comfortably then habitually, oral medication is started without delay – Amoxicillin or a penicillin derivative with ongoing referral to an orthodontist for prompt investigation. If the sufferer is dehydrated, unable to swallow and seemingly very unwell then hospital admittance is the probable course of action. There, antibiotics can be offered intravenously to stem the rising infection whilst the underlying cause is determined. The speediest route to establish the cradle of the issue is to CT or CAT scan the maxillofacial area in its entirety. If a tooth is a culprit, extraction is an option unless it is a permanent and visible tooth in which situation efforts may be made to treat the infection with long-term antibiotics leaving the tooth in situ. On occasion, it is simply not possible to salvage the tooth which may give rise to recurrent and repeated infections only relieved by ultimate removal. In juveniles, there is little implication in extrication of milk teeth.
Facial cellulitis – a guide in pictures
View our pictorial guide borrowed from a med school student lecture. It’s easy to be distracted by the sometimes explicit imagery. Don’t just focus on the obvious cardinal source of origin but note also the subsequent cellulitis as a corollary to the principal infection.
Pictures of facial cellulitis are a clear and helpful tool in understanding how this unpleasant infection may manifest on the face.
Sinusitis and its correlation with facial cellulitis
The sinuses are hollow, air-filled cavities in the face connected to the nose by a narrow aperture called the ostium. The human head has four pairs, the maxillary sinus sited behind the cheeks, the ethmoid sinus (roughly between the eyes), the sphenoid sinus which sits behind this and the frontal sinus in the forehead. Collectively, these are labelled, the ‘paranasal sinuses’. This definition in Wiki explains more.
Their location and capacity to harbour bacteria enable the sinus to act as a tremendous haven for infection, commonly introduced and tracking via the respiratory airways and nasal passages. Inflammation may transit into an infection. Pain is a common symptom, specifically tenderness to the touch or when bending down. There may be congestion initially followed later by fluid draining from the nostrils of a cloudy hue. Equally, overflowing sinus contents can drip down the throat causing coughing and irritation. There may also be symptoms of toothache as the expanding sinus causes pressure along the jaw bone. Earache, halitosis (bad breath) and sore eyes are other indications associated with a sinus infection. Facial cellulitis may unfold as a corollary of a basal sinus infection.
What are the generic symptoms of facial cellulitis?
In broad terms, flushing, redness or high face colour and filling and congestion of the skin. Throbbing and aching of the affected area with an increasing spread if the infection remains untreated.
It is possible that the cellulitis has a primary cause of origin such as a graze or scratch but customarily, the symptoms of facial cellulitis form part of an unwelcome package with another complication.
What is the current treatment protocol for facial cellulitis?
Up to date treatment guidelines state immediate antibiotic intercession, the method and type dependent on overall health status and a full assessment of clinical history. In tandem, the point of origin from which the cellulitis emanates needs to be diagnostically evaluated. Whether this is a wound or other systemic affliction, it will require attention as well. Treatment for facial cellulitis often involves a more in-depth response than first appears on the surface.
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