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February 21, 2013, last updated February 9, 2015

By Alison Turner, Featured Columnist

6. Angioedema Plus Tooth Problems: Formula for Facial

Angioedema is swelling that is similar to hives, except that
the swelling takes place under the skin rather than on the
surface.  This swelling often occurs around the eyes and
lips though can also happen in the hands, feet, and throat.  
This condition may be caused during an allergic reaction
from animal dander, foods, insects, medication, pollen, or
even sunlight, cold or heat.  The National Libraries of Health
reports that in most cases, "the cause of angioedema is
never found."

In 2011, Dr. Konrad Bork with the Department of
Dermatology at the Johannes Gutenberg University in
Mainz, Germany, along with other German scientists,  noted
that “tooth extractions may trigger clinical symptoms of
hereditary angioedema due to C1 inhibitor deficiency.”  

Thus, the team aimed to determine how many tooth
extractions were followed by symptoms of angioedema
with and without “preoperative short-term prophylaxis
with C1 inhibitor concentrate.” Clinical files of 171 patients
were assessed, revealing that “facial swelling or potentially
life-threatening laryngeal edema, or both, occurred in
124/577 tooth extractions (21.5%) without prophylaxis.”  

They concluded that “short-term prophylaxis with C1
inhibitor concentrate significantly reduces the risk” of
angioedema symptoms after tooth extraction.

If your tooth extraction appointment glares at you from
your calendar for next week, consider asking your dentist
about “prophylaxis with C1 inhibitor concentrate” to
reduce the risk of swelling: worst case scenario, you get to
surprise your dentist with all of those big words.

Marasmus in the Developed World: Facial Swelling from
Celiac Disease?

Marasmus is the name given to extreme lack of protein and
energy that, in the words of World Food Programme,
creates a "skeletally thin" appearance.  In the worst of
marasmus cases, the malnutrition can lead to kwashiorkor
which causes swelling, including the perhaps deceivingly-
poetic condition of "moon face."   If you're reading this
article, you're probably lucky enough to not have to worry
about the kind of conditions that lead to marasmus.
However, research from 2008 shows that some people with
celiac disease may share some of marasmus’ symptoms.

The study was conducted by Dr. Peter H.R. Green with the
Celiac Disease Center at Columbia University and
colleagues,  who identified patients receiving a new
diagnosis of
celiac disease.  Using data from 10.2 million
"managed care members across the United States" between
the years of 1999 and 2003, the team found not only an
increase in the rate of celiac disease in the four year study
period, but also an increase in the "number of associated
conditions" with celiac disease.  Perhaps surprisingly,
nutritional marasmus made it into the "top 5 conditions
with the highest occurrence of celiac disease diagnosis,"
with a rate of 1 person having marasmus out of every 65
patients with celiac disease.

Odds are that if you or someone you know has marasmus
you will notice his, her, or your own "skeletally thin"
appearance before the slightly swollen "moon face."  Then
again, if you know someone who's face is swollen, and
who may not be getting adequate nutrition (either because
of celiac disease, an unbalanced or extreme diet or some
other condition) it may be a sign that it's time to work on a
balanced diet. (Read more about the
causes of celiac
disease and natural remedies that help.)

Lemierre Syndrome Can Make Your Face Puffy

Lemierre syndrome was at one point known as “the
forgotten disease” because of how rarely it occurred,
though is now thought to be more common  particularly in
adolescents and young adults.   The syndrome is
characterized by a history of oropharygneal infection (that
is, infection in part of the throat), internal jugular
thrombosis (clotting),  and, according to research from
Seattle, facial swelling.

In 2010, Dr. James Ridgway with the Department of
Otolaryngology at the University of Washington in Seattle
and a team of experts  described their experiences with
three cases of Lemierre syndrome.  All three cases showed
fever, sore throat, neck pain, and fatigue, and one of the
patients “developed right facial swelling.”  For the patient
with facial swelling, the team performed drainage of “a
right peritonsillar abscess” amongst other procedures,
after which he required 9 weeks of antibiotic therapy.  The
team reports that “timing was crucial” and conclude that
“aggressive antibiotic therapy coupled with surgical
intervention, when necessary, provides excellent

If you suffer from Lemierre syndrome it’s probably
impossible for you to “forget,” despite the condition’s
historical tag line.  If your face is swelling while
experiencing the other symptoms listed above, consider
seeking a professional for consultation about Lemierre
syndrome: it’s a condition better addressed than forgotten.

Facial Swelling from Jaw Problems --Beware of Mis-

When you have facial swelling and a history of jaw
problems, doctors often assume the probme is TMD.
Temporomandibular disorder (TMD) is pain or problems in
the joint connecting the jawbone to the skull.  Facial
swelling can lead to a diagnosis of TMD, though experts in
Chicago warn that such a diagnosis may be hasty : swelling
and other symptoms in the jaw area could really be a tumor.

In 2009, G.D. Klasser with the Department of Medicine and
Diagnostic Sciences at the University of Illinois at Chicago
led a team of researchers  in an investigation of two
patients “with parotid gland masses accompanied by pain,
dysfunction and other symptoms.”  

At first, both patients were thought to have TMDs (also
called TMJ).  The facial swelling associated with one of the
cases was lessened after prescribed analgesics, and anti-
inflammatory and muscle-relaxant medications until he
began to experience numbness on the previously-swollen
side of his face, and a “decrease in his ability to open his

It turned out that the problem was not TMD --- it was a
tumor. Cranial nerve examinations exposed numbness of
the nerves and a “tender parotid mass” that was “fixed to
underlying tissues.”  In both cases, clinicians “reached an
incorrect diagnosis and treated the masses as if they were

This mis-diagnosis “delayed a definitive diagnosis and
provision of appropriate treatment.”  

The team recommends that dentists “take a thorough
patient history,” and that they “must recognize the
possibility that a head or neck malignancy may manifest
with symptoms and signs that mimic TMDs.”  If you do get
your swelling and jaw pains checked out, remember: a TMD
diagnosis (if it’s correct) could actually be good news.

Puffy Face in Children: Possible  Sinus Issues.

Most of us walk around all day without knowing it, but we
have a channel in us called a naso-frontal dermal sinus.  
Researchers in Tunisia demonstrated how this channel of
the nose can have particular significance in children, whose
faces may swell due to problems in that area.

In 2012, Limeme Manel with the Imaging Department at
Farhat Hached Hospital in Sousse, Tunisia  led a team of
researchers in an analysis of the “midface swelling” that
hints at naso-frontal dermal sinuses.  They reported on two
cases of naso-frontal dermal sinuses, the first of which
presented with soft tissue swelling and inflammation.  

Studies revealed “microabscesses located at the left
orbitonasal soft tissues, a frontal bone defect, and an
intracranial cyst.”  Surgical excision was performed, the
results of which were “favorable.”  The experts emphasize
“the role of imaging methods in confirming the diagnosis
and looking for associated cysts.”  Furthermore,
“knowledge of the typical clinical presentations,” such as
facial swelling, is “needed to formulate a differential

Facial swelling in children is more common than any of us
would ever desire.  This swelling could be slow and
progressive, acute, or rapidly progressive, arising from a
sundry of conditions,  including cysts or defects in the naso-
frontal dermal sinus.  If your child’s face looks puffier than
it ever has before, consider seeking a professional for

Bonus Tip:

Swollen Lymph Nodes and Blocked Glands Can Cause
Facial Swelling

One of the most common causes of facial swelling are
lymph node infections. Swelling on one side of your face,
especially, can indicate lymph node involvement  or
salivary glands which can usually be quickly cleared up with
proper treatment. (Read more about
remedies for swollen
lymph nodes or remedies for blocked salivary glands.)

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Add foods rich in potassium, such as
bananas, to your diet to reduce facial
swelling caused by too much salt.