What could be causing persistent pain and swelling on the left side of my face that extends to the neck area, accompanied by inflammation and dizziness?

Urgent Evaluation Required for Left-Sided Facial Pain with Neck Extension and Dizziness

You need immediate medical evaluation to rule out giant cell arteritis (temporal arteritis), which can cause permanent vision loss if untreated, especially if you are over 50 years old. 1

Critical Red Flags Requiring Emergency Assessment

Your symptom constellation—unilateral facial pain extending to the neck with persistent swelling, inflammation, and dizziness—demands urgent evaluation for several potentially serious conditions:

Giant Cell Arteritis (Most Urgent if Age >50)

• Immediate ESR and C-reactive protein testing is mandatory if you are over 50 years old, as giant cell arteritis presents with jaw claudication, temporal region pain, scalp tenderness, and systemic symptoms like malaise. 1
• Physical examination should assess for absent temporal artery pulse, temporal artery tenderness, and possible tongue cyanosis. 1
• High-dose corticosteroids (minimum 40 mg prednisone daily) must be started immediately if suspected—do not wait for biopsy results, as vision loss from ophthalmic artery involvement is a devastating complication. 1
• Temporal artery biopsy should be obtained within 2 weeks of starting treatment. 1

Cardiovascular Disease

• Left-sided facial pain extending to the neck can represent cardiac ischemia, particularly if pain worsens with physical activity and improves with rest. 2
• Ischemic heart disease may manifest solely as facial pain in the mandibular region, eye, and neck, especially in patients with cardiovascular risk factors. 2
• Immediate cardiac evaluation is warranted if you have risk factors (hypertension, diabetes, smoking, family history) or if pain is exercise-related. 2

Neurological Causes to Consider

Trigeminal Neuralgia

• Characterized by paroxysmal, electric shock-like pain in the trigeminal distribution, triggered by light touch, washing, eating, or brushing teeth, with refractory periods between attacks. 1, 3
• MRI with contrast is essential to exclude tumors, multiple sclerosis, or neurovascular compression. 1
• First-line treatment is carbamazepine if this diagnosis is confirmed. 1, 3, 4

Occipital Neuralgia with Referred Pain

• Chronic occipital neuralgia can cause hemifacial pain and sensory disturbances through sensitization of the trigeminocervical complex. 5
• Pathological vascular contact of the greater occipital nerve may produce continuous unilateral facial pain extending from the occipital region. 5

Infectious and Structural Causes

Sinusitis

• Acute sinusitis can present with facial swelling, tenderness over affected areas, and purulent secretions persisting beyond 10 days. 6
• Red, swollen nasal tissue with yellow-green, opaque secretions in the middle meatus are characteristic. 6
• Rarely, orbital involvement can cause diplopia or proptosis. 6
• CT imaging is optimal for evaluating the ethmoid sinuses and ostiomeatal complex if sinusitis is suspected. 6

Salivary Gland Pathology

• Tumors or salivary stones can cause intermittent pain and swelling, particularly before eating. 1
• Bimanual palpation may reveal stones, with slow or absent salivary flow from the affected duct. 1
• Ultrasound imaging is useful for diagnosis, with referral to oral/maxillofacial surgery indicated. 1

Immediate Action Plan

Do not delay seeking medical attention. Your symptoms require:

1. Immediate blood work: ESR and CRP to screen for giant cell arteritis if age >50. 1
2. Physical examination: Palpation of temporal arteries for tenderness, nodularity, or absent pulse; cranial nerve examination; assessment of cardiovascular risk factors. 1, 2
3. Imaging: MRI with contrast for suspected neurological causes; CT for suspected sinusitis or structural lesions. 6, 1, 7
4. Cardiac evaluation: If pain is exercise-related or you have cardiovascular risk factors. 2

Critical Pitfalls to Avoid

• Never dismiss unilateral facial pain with systemic symptoms in patients over 50 without ruling out giant cell arteritis—vision loss is irreversible. 1
• Do not attribute all facial swelling to dental causes without considering sinusitis, salivary pathology, or more serious conditions. 6
• Dizziness combined with facial pain may indicate cardiovascular compromise or neurological pathology requiring urgent evaluation. 2

Seek emergency or urgent care evaluation today, particularly if you are over 50, have cardiovascular risk factors, or if symptoms worsen with activity.