Differential Diagnosis for 79-year-old with Sudden Onset Painful Swelling
- Single most likely diagnosis:
- Temporomandibular joint (TMJ) disorder or temporomandibular dysfunction: The symptoms of painful swelling, difficulty opening the mouth, and increased pain on bending are highly suggestive of a TMJ issue, possibly exacerbated by an acute injury or condition such as a dislocated jaw or TMJ inflammation.
- Other Likely diagnoses:
- Dental abscess or infection: Given the location and symptoms, an abscess or infection related to a tooth could cause swelling, pain, and difficulty opening the mouth.
- Parotid gland infection or inflammation: Inflammation of the parotid gland (parotitis) could cause swelling and pain in the area described, especially if it's related to a bacterial or viral infection.
- Masticatory space infection: An infection in the masticatory space, which includes muscles of mastication, could lead to swelling, pain, and difficulty moving the jaw.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Angioedema: Although less common, angioedema could cause sudden swelling and potentially life-threatening airway obstruction if not promptly treated.
- Ludwig's angina: A severe infection of the submandibular space that can cause swelling, pain, and difficulty opening the mouth, with potential for airway compromise.
- Temporal arteritis: Inflammation of the temporal arteries could cause jaw claudication (pain when chewing) and is a medical emergency due to the risk of blindness if not treated promptly.
- Rare diagnoses:
- Salivary gland tumor: Although rare, a tumor of the salivary gland could cause a painful swelling, especially if it becomes infected or is large enough to cause mechanical symptoms.
- Osteonecrosis of the jaw: More commonly associated with long-term bisphosphonate use, this condition could cause jaw pain and swelling, especially in the context of recent dental procedures.
- Actinomycosis: A rare bacterial infection that can cause chronic swelling and pain, often related to dental procedures or poor dental hygiene.