Health Library Facial Problems, NoninjuryFrom Healthwise

Facial problems can be caused by a minor problem or a serious condition. Symptoms may include pain, swelling, or facial weakness or numbness. You may feel these symptoms in your teeth, jaw, tongue, ear, sinuses, eyes, salivary glands, blood vessels, or nerves.

Common causes of facial problems include infection, conditions that affect the skin of the face, and other diseases.

Infections

• Bacterial infections such as impetigo and cellulitis can cause facial pain and oozing blisters or sores.
• Viral infections such as shingles may affect nerves in the face or head, causing severe facial pain or eye problems (keratitis).
• An infected or blocked salivary gland or a salivary stone (sialolithiasis) may cause facial swelling or pain, especially in the parotid gland (parotitis), which is located near the ear.
• Lyme disease is an infection that is spread by the bite of ticks infected with a bacteria. It may cause facial pain, headache, stiff neck, or paralysis of the facial nerves.

Skin conditions

• Rosacea is a chronic skin condition that causes redness on the face, usually on the cheeks, nose, chin, or forehead.
• Acne commonly occurs on the face, especially in teens and young adults.
• Seborrheic dermatitis causes red, itchy, flaky skin patches along the eyebrows, nose, and mouth.

Other conditions and diseases

• Sinusitis causes a feeling of pressure on the face. Sinusitis can follow a cold or may be caused by hay fever, asthma, or air pollution. It is more common in adults, but it can occur in children as an ongoing (chronic) stuffy nose. See a picture of the facial sinus cavities.
• Dental problems, including infections, can cause facial pain and swelling in and around the jaw area. Jaw pain may be caused by a temporomandibular (TM) joint problem. This condition can cause pain in the TM joint (located in front of the ear), in the ear, or above the ear. For more information, see the topic Mouth Problems, Noninjury.
• Headaches, such as migraines or cluster headaches, can cause severe pain around the eyes, in the temple, or over the forehead. Giant cell arteritis generally affects older adults and may cause headache and pain and may lead to blindness if not treated. For more information, see the topic Headaches.
• Trigeminal neuralgia is a condition that causes abnormal stimulation of one of the facial nerves. It causes episodes of shooting facial pain.
• Closed-angle glaucoma causes vision changes and severe, aching pain in or behind the eye.
• Conditions that cause problems with the muscles or nerves in the face include:
  • Bell's palsy, which is caused by paralysis of the facial nerve. Weak and sagging muscles on one side of the face is the most common symptom. It also may cause an inability to close one eye and mild pain in the facial muscles.
  • Multiple sclerosis, which may affect facial muscle control and strength, vision, and cause changes in feeling or sensation.
  • Myasthenia gravis, which causes facial muscle weakness leading to drooping eyelids and difficulty talking, chewing, swallowing, or breathing.
  • Facial paralysis from a stroke.
• Lupus causes inflammation, fatigue, and a butterfly-shaped rash across the cheeks.

Treatment depends on what is causing your facial problem. In many cases, home treatment may be all that is needed to relieve your symptoms.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

• Signs of moderate to severe difficulty breathing:
  • In a child
  • In an adult and older child
• Signs of shock
  • In children
  • In adults and older children
• Symptoms of an allergic reaction, such as hives with difficulty breathing or rapid swelling of the throat, tongue, lips, or face
• Sudden weakness, numbness, paralysis, or drooping of facial muscles with other loss of function
• Facial or jaw pain with chest pain (crushing or squeezing or feels like a heavy weight on the chest) and other symptoms of a heart attack
• Sudden partial or complete loss of vision in one or both eyes. Note: Treatment is needed within 90 minutes to save vision.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Possible allergic reaction: Go to the topic Allergic Reaction.
• An injury to your face: Go to the topics Facial Injuries, Nose Injuries, or Eye Injuries.
• A headache: Go to the topic Headaches.
• Facial pain or swelling following a burn, sunburn, or exposure to cold temperature: Go to the topics Burns, Sunburn, or Cold Temperature Exposure.
• A rash: Go to the topic Rash, Age 12 and Older.

	Yes	Do you have any vision changes?
When to See a Doctor See significance of vision changes if you need more information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have eye pain? Yes Do you have any aching around one or both eyes without loss of vision? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have changes in feeling or sensation in your face, but you do not have other loss of function?
When to See a Doctor See significance of changes in feeling or sensation if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have facial weakness or paralysis? Yes Do you have facial numbness or tingling? Yes Do you have drooping facial muscles? Yes Are you having trouble closing your eye? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have facial pain?
When to See a Doctor See significance of facial pain if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have severe facial pain? Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you had episodes of severe shooting pain on one side of your face? Yes Have you had moderate facial pain for longer than 24 hours? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you had mild facial pain for longer than 1 week that has not been evaluated by a health professional? Yes Have you had mild facial pain that has changed or become worse since being evaluated by a health professional? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have facial swelling?
When to See a Doctor See significance of swelling if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a fever with redness, tenderness, and warmth around your eye? Yes Do you have sudden swelling of the lips, tongue, throat, eyelids, or ears? Yes Did facial swelling begin after taking a medicine? Note: If you answer "Yes": Call the health professional who prescribed the medicine immediately, before taking the next dose, to determine whether you should stop taking the medicine or take a different one. An appointment may not be needed. If you are taking a nonprescription medicine, stop taking the medicine. Call your health professional if you feel you need to continue taking the medicine. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a red, painful area larger than 1 in. (2.5 cm) in diameter on your face? Yes Do you have pain on one or both sides of the face, along the jawline, or under your chin? Yes Do you have a toothache? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Do you have a red, painful area on your face that is increasing in size after 24 hours of home treatment? Yes Do you have a red, painful area on your face that has not gotten better after 24 hours of home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have sinus pain or pressure?
When to See a Doctor See significance of sinus pain or pressure if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have severe pain? Call your health professional today if you answer "Yes" to the following question. Yes Do you have moderate sinus pain or pressure with yellow or green nasal discharge? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have mild pain and yellow or green nasal discharge that has not improved after 48 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had sinus pressure with any nasal discharge that comes and goes and has continued for longer than 1 week? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you continue to have facial symptoms despite treatment with antibiotics?
When to See a Doctor See significance of symptoms after treatment with antibiotics if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Are you taking an antibiotic, but your symptoms are not following the expected course? Note: A change in medicine or a change in the dose may be needed. An appointment may not be necessary. Yes Do you have a rash or other side effects, such as diarrhea or nausea, after taking an antibiotic? Note: Do not take your next dose of medicine until you have talked with your health professional. Yes After taking an antibiotic for a sinus infection for 72 hours, do you have new yellow or green nasal discharge? Note: A change in medicine or a change in the dose may be needed. An appointment may not be necessary. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a rash or blisters on the face?
When to See a Doctor See significance of a rash or blisters if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you have a rash or blisters on your face? Note: Call your health professional as soon as possible. If your rash is caused by shingles, there may be a medicine you can take that will limit the pain and rash. Medicines are most effective if begun within 2 to 3 days of the start of the rash. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Dental or mouth problems: Go to the topic Mouth Problems, Noninjury.
• Jaw problems: Go to the topic Temporomandibular (TM) Disorders.
• A painful facial lump: Go to the topic Swollen Glands and Other Lumps Under the Skin.
• An insect or spider bite or sting: Go to the topic Insect Bites and Stings and Spider Bites.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Facial or sinus pressure, mild headache, or nasal stuffiness are common with a cold or flu. Home treatment can help relieve your symptoms.

• Drink plenty of fluids. Extra fluids help keep mucus thin and draining, which may help prevent blockage of the sinuses.
  • Adults require 8 fl oz (237 mL) of water or juice every hour.
  • Children require about half that amount.
• Use a humidifier to keep the air in your home moist.
• Inhale steam from a vaporizer, or take long, steamy showers. You may also try breathing the moist air from a bowl of hot water. Put a towel over your head and the bowl to trap the moist air. Make sure the water isn't too hot. Be careful not to get burned by the hot water or steam.
• Use saltwater nasal washes to help keep the nasal passages open and wash out mucus and bacteria. It also may help to gargle with warm salt water. [Add 1 tsp (5 g) to 16 fl oz (473 mL) of water.]
• Put warm, wet compresses on your eyes and cheekbones if you have pain around that area. Washcloths dipped in hot water work well. Make sure the water is not too hot so you do not get burned.
• Avoid alcohol. It makes the tissues lining your nose and sinuses swell up.
• Do not swim in chlorinated swimming pools. Chlorine can irritate nasal and sinus linings.
• Elevate your head at night. Some people find it helpful to sleep on 2 or 3 pillows.
• Use decongestants to relieve nasal stuffiness. Decongestants can be taken by mouth or used as nose drops or sprays. Oral decongestants, such as pseudoephedrine (Sudafed), are probably more effective and provide longer relief, but they cause more side effects. Sprays and drops provide rapid but temporary relief. Check with your doctor before using nonprescription medicines if you have high blood pressure or kidney disease. In some states, medicines containing pseudoephedrine (such as Sudafed) are kept behind the pharmacist's counter or require a prescription. You may need to ask the pharmacist for it or have a prescription from your doctor to buy the medicine.
• Don't give these medicines to a child younger than 2 unless you've checked with the doctor first. If your child’s doctor tells you to give a medicine, be sure to follow what he or she tells you to do.

Do not smoke or use other tobacco products. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Tobacco Use.

For home treatment measures on other types of facial symptoms, such as eye, nose, mouth, or ear, see the specific topic in Related Information.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Facial pain or swelling increases.
• Fever, headache, and nasal discharge become worse.
• Vision changes develop.
• Painful facial rash develops.
• Facial feeling or sensation changes develop.
• Symptoms continue despite home treatment.
• Symptoms become more severe or more frequent.

The following home treatment measures may help prevent sinusitis.

• Use a humidifier to keep the air in your home moist.
• Treat colds promptly. Blow your nose gently. Do not close one nostril when blowing your nose.
• Drink extra fluids when you have a cold. This helps keep mucus thin and draining.
• Do not drink alcohol. It makes the tissues lining your nose and sinuses swell up.
• Do not smoke or use other tobacco products. Smokers are more prone to sinusitis. For more information, see the topic Quitting Tobacco Use in Related Information. Avoid secondhand smoke.
• Use a decongestant nasal spray before or during airplane flights, especially during landing.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• What are your main symptoms? How long have you had your symptoms?
• Have you had this problem before? If so, how was it treated?
• What makes your symptoms better or worse?
• Have you recently had a cough, cold symptoms, allergies, or headaches? Be prepared to describe any nasal drainage or sputum coughed up, or the location and severity of headaches.
• Have you had an injury to this area? Do you have any continuing problems because of a previous injury?
• What home treatment measures have you tried? Did they help?
• What prescription or nonprescription medicines do you take?
• Do you have any health risks?

• Allergic Reaction
• Allergic Rhinitis
• Bell's Palsy
• Cluster Headaches
• Cold Temperature Exposure
• Eye Injuries
• Eye Problems, Noninjury
• Facial Injuries
• Head Injury, Age 3 and Younger
• Head Injury, Age 4 and Older
• Headaches
• Influenza
• Insect Bites and Stings and Spider Bites
• Lyme Disease
• Migraine Headaches
• Mouth and Dental Injuries
• Mouth Problems, Noninjury
• Multiple Sclerosis (MS)
• Nose Injuries
• Quitting Tobacco Use
• Scalp Problems
• Shingles
• Sinusitis
• Sore Throat
• Swollen Glands and Other Lumps Under the Skin
• Temporomandibular (TM) Disorders
• Tension Headaches
• Tooth Decay

Author:	Jan Nissl, RN, BS	Last Updated: May 15, 2007
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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