The face: Common symptoms

Facial pain

A sharp separation of facial and headaches is often difficult because the pain manifestations can merge. Sometimes the pain is clearly due to a cause in the ENT field of expertise. Pain in the mid-face area, over the cheeks, around the root of the nose, and over the forehead may indicate, for example, a nose or sinus disease, while lateral face pain might indicate a salivary gland disease, or an ear infection. Sometimes the ENT specialist can not find a clear cause in his or her area of expertise, but can refer the patient to another colleague with a specific question.

Skin changes in the face/scalp

In the facial area a variety of skin diseases can become visible, even though the face does not have to be the only place of manifestation, but one among others. Often it takes the final diagnosis of the judgement of a dermatologist. Sometimes they are also an expression of a general illness. In both cases, we refer the patients to the appropriate specialists.
Skin lesions on sun-exposed areas, particularly the nose, ears or scalp, may indicate malignant changes (basal cell carcinoma, spinalioma, melanoma) and are surgically removed by the ENT specialist, taking into account aesthetic and functional aspects.

Swelling and knots in the face and neck

Swelling in the face may be diffuse or clearly located. Diffuse changes are often an expression of a general disease, which is clarified by the appropriate specialist doctors. Localised swelling or lumps are considered to be complications of various ENT diseases, but may also be the first symptom. Depending on the localisation and concomitant symptoms and on the most accurate examination, the cause can often be suspected. Swelling in front of the ear or lower jaw may indicate a salivary gland disease, a swelling over the cheek indicates a paranasal sinus or a tooth affection, lumps on the neck could be cysts, inflammatory diseases or tumours. An ultrasound examination is the further investigation of choice especially for lumps on the neck. Under sonography, a puncture can be performed and material obtained for histological examination.

Facial paralysis (facial palsy)

Unilateral facial paralysis is a dramatic event for the patient. Waking up and realising that one can not close the eye or that the corner of the mouth droops and a smile is no longer possible, is frightening. It is crucial at the beginning of such a disease, to find out whether it is a central (for example a stroke) or a peripheral paralysis. In the case of a central lesion, the function of the frontal branch is preserved, often other symptoms such as paralysis of the legs or arms and speech problems occur and the patient should be taken directly to a specialised emergency department. In peripheral paralysis, all branches of the facial nerve are usually affected and thus the forehead no longer shows any facial expressions. Since the facial nerve is in close proximity to the salivary glands and the ear, the ENT specialist will perform a thorough medical examination, including blood tests and ultrasound, sometimes supplemented by an imaging procedure. In some cases, there is no clear cause and we speak of “idiopathic facial paralysis” or Bell’s palsy, which often recovers completely by itself. This may take weeks or months and, in addition to protecting the eye from dehydration and therefore corneal injury, requires the accompaniment of a specialised speech therapist to prevent subsequent malfunction.