Understanding Swollen Cheeks : Causes, Diagnosis, and Treatment

1. Introduction

   1. Definition of Swollen Cheeks

      Swollen cheek is facial swelling or edema of the cheeks. It refers to an abnormal enlargement or puffiness of the soft tissue in one or both cheeks.

      Various medical conditions affecting the facial region can lead to swollen cheeks. It can be a symptom of any other health condition and may vary in severity. There can be a mild localized swelling to more pronounced and widespread edema.

      Knowing about the cause of swollen cheeks is important for proper diagnosis and appropriate treatment.

   2. Clinical Implication Of Knowing About The Cause Of Swollen Cheeks

      Knowing the cause is important for several reasons:

      • Accurate Diagnosis: Identifying the causes is important as it allows healthcare professionals to make accurate diagnoses. Also, it is crucial for appropriate treatment and management strategies.
      • Targeted Treatment: Different causes require different treatments. For example, if the swelling is due to an allergic reaction, antihistamines may be effective, whereas infection may require antibiotics.
      • Preventing Complications: Some causes of swollen cheeks may lead to serious complications if left untreated.
      • Avoiding unnecessary Interventions: If the cause of swollen cheeks is benign or self-limiting, knowing the cause can help prevent unnecessary tests, procedures, and treatment that may carry risk or have no therapeutic benefit.
      • Prognostic Information: Understanding the cause can help predict the course of the condition and the likelihood of recovery or recurrence.
      • Patient Education and Counselling: The healthcare providers can educate the patient about the condition, its potential causes, and the importance of adherence to the prescribed treatment plan.
      • Differential Diagnosis: Identifying the cause can help narrow down the differential diagnosis and guide further investigations.
      • Multidisciplinary care: It can help facilitate appropriate referrals and collaboration among healthcare professionals for comprehensive patient care.

2. Common Causes of Swollen Cheeks

   Swollen cheeks can be caused by various factors. Some of the common causes include:

   • Dental Issues: There can be localized swelling in the cheek region due to an infection or abscesses in the teeth or gums.
   • Salivary Gland Infections: Infections of the salivary gland such as parotitis can lead to swelling in the cheeks Mumps is a contagious viral infection that affects the salivary glands.⁽²⁾
   • Allergic Reactions: Certain food or medication allergies, insect stings or environmental factors can cause facial swelling, including swelling in the cheeks.
   • Sinus Infections: Inflammation of the sinuses can lead to facial swelling, including the cheeks. This is due to the proximity of the sinuses to the facial tissues.
   • Angioedema: This condition is characterized by swelling of the deeper layers of the skin affecting the face including the cheeks. It can occur due to an allergic reaction or a side effect of a medication.
   • Trauma: Injury or trauma to the face such as fractures or soft tissue injuries can lead to localized swelling, including the cheeks.
   • Cystic Acne: Several forms of acne can lead to the formation of large painful cysts on the face that can also cause swelling on the face.
   • Medication Side Effects: Some medications can cause swelling of the face as a side effect.
   • Inflammatory conditions: Systemic lupus erythematosus or other autoimmune diseases can lead to facial swelling including swelling of the face.
   • Obesity: Excess weight contributes to facial swelling in some individuals, particularly in the lower part of the face including cheeks.
   • Hypothyroidism: It is a condition in which the thyroid gland does not produce enough hormones to meet the demands. Weight gain and puffiness of the face are the common symptoms of hypothyroidism.⁽⁵⁾ 
   • Cushing Syndrome: It is a condition in which the adrenal glands produce too much cortisol. Individuals with Cushing’s syndrome may experience weight gain and puffiness of the face.

3. Uncommon Causes of Swollen Cheeks

   Uncommon causes of swollen cheeks are less encountered conditions that can cause facial swelling. These are relatively rare as compared to the common ones above.

   • Granulomatosis with Polyangiitis (Wegener’s Granulomatosis): Inflammation of the blood vessels leads to this rare autoimmune disorder, leading to granuloma. The patient experiences facial swelling, including swollen cheeks.
   • Pericoronitis: It is the inflammation of the gums around the tooth that is only partially emerged. Mostly the 3rd molars or the wisdom teeth are seen as being commonly affected by it.⁽⁶⁾ This can cause swelling of the cheek.
   • Salivary Gland Tumors: Tumors in the salivary glands can be benign or malignant. Their exact causes can vary, but when they occur, they can lead to facial swelling.
   • Salivary Stones: These are calcium deposits that form in the salivary gland.⁽³⁾ It is also termed sialolithiasis
   • Sarcoidosis: It is an inflammatory condition that affects various organs including the lungs and lymph nodes. It may cause facial swelling in some people.
   • Lymphoma: It is a cancer affecting the lymphatic system. There is swelling of the lymph nodes of the head and neck region, including the cheeks.
   • Metastatic Tumors: In rare cases, the spread of tumors from other parts of the body may cause swelling of the cheeks.
   • Tuberculosis: In rare cases, tuberculosis may involve the salivary gland or lymph nodes of the face, leading to facial swelling.
   • Actinomycosis: Actinomycosis is caused by Actinomyces bacteria. Bacterial infection may cause abscesses in the soft tissues including cheeks.
   • Sjogren’s Syndrome: It is an autoimmune condition that may lead to inflammation of the salivary gland and lead to swollen cheeks.⁽⁴⁾
   • Hypersensitivity Reaction: Hypersensitivity reaction to certain medications, foods, or substances can lead to facial swelling, including the cheeks.

   These causes may be less common but they still can occur. A thorough evaluation is necessary for accurate diagnosis and appropriate management.

4. Diagnosis and Treatment of Different Causes of Swollen Cheek

   Diagnosis of Swollen Cheek

   A physical exam is typically one of the first steps in the diagnostic process to identify the cause of swelling. Also, the following tests may be recommended to diagnose the cause:

   • CT scan, MRI scan, and X-ray are ordered to evaluate the extent of swelling and identify structural abnormalities
   • Blood tests can be helpful in finding out the signs of infection or a thyroid problem
   • Urinalysis can help detect signs of systemic infections or kidney problems.
   • A biopsy can help look for cancerous cells in the mouth and throat

   Treatment for Swollen Cheek

   Different types of treatment are recommended depending on the cause to help alleviate swollen cheeks. These include medication, surgery, or both.

   • For minor injuries cold compress is advised as it can be helpful in relieving swelling and pain. The person is allowed to keep the head elevated and gently massage the cheeks to reduce swelling.
   • Antibiotic treatment is given if the swollen face is due to infections such as lymphadenitis, cellulitis, or pericoronitis.
   • Abscess is treated by draining it followed by antibiotic treatment.
   • Anti-inflammatory medications are given to reduce pain and swelling.
   • The treatment of oral cancer depends on the type, location, and stage of the cancer.⁽⁷⁾
   • Cushing syndrome can be treated with medications that lower cortisol levels or decrease adrenocorticotrophic hormone production in the pituitary glands.⁽⁸⁾

   Also, if along with swollen cheeks, there is swelling of the face, lip, and tongue, a skin rash, difficulty in breathing, or dizziness, immediate medical attention should be received.

A swollen cheek can arise from a myriad of causes, with some being more concerning than others. A diverse array of treatments exists, tailored to address the specific underlying reasons. Except for minor injuries, seeking medical attention is paramount, especially if the swelling is severe or manifests suddenly.

The correct identification of the cause behind a swollen cheek carries profound clinical ramifications. Precise diagnosis paves the way for targeted treatments. It is imperative for healthcare professionals to stay vigilant, taking into account both prevalent and rare causes, to ensure optimal patient care.

The collaboration among varied medical specialties, utilization of cutting-edge diagnostic tools, and relentless pursuit of research have collectively enhanced our grasp on rarer causes and the broader clinical picture. By upholding a keen sense of discernment, staying abreast of new findings, and championing cross-disciplinary collaboration, the complexities of infrequent cases can be tackled, enhancing both the prognosis and quality of life for patients grappling with facial swelling.