What is the treatment for cheek swelling?

Treatment of Cheek Swelling

The treatment of cheek swelling depends entirely on the underlying cause, which must be identified through targeted assessment before initiating therapy. The most critical initial step is determining whether the swelling represents a life-threatening condition (airway compromise, giant cell arteritis) versus a more benign process (dental infection, inflammatory conditions).

Immediate Assessment Priorities

Rule Out Emergent Conditions First

• Assess for airway compromise if swelling involves the submandibular region or extends toward the neck, as acute sialadenitis or angioedema can progress to respiratory failure requiring intubation or tracheostomy 1
• Evaluate for giant cell arteritis in patients over 50 years with jaw claudication (pain with chewing) by immediately checking ESR and C-reactive protein, as delay in treatment can result in permanent vision loss 2
• Consider angioedema if swelling is episodic, nonurticarial, and progressively worsens over 24 hours, as standard treatments (epinephrine, antihistamines, corticosteroids) are ineffective for hereditary angioedema 1

Identify the Most Common Causes

• Examine for dental pathology including tooth mobility, gingival swelling, parulis (gum abscess), or tooth discoloration, as dental infection is the most common and time-sensitive diagnosis 2
• Obtain trauma history including recent dental injury, falls, or facial trauma that can cause delayed complications 2
• Assess for maxillary sinusitis with coexisting conditions such as postsurgical/posttraumatic defects in the anterior antral wall, fungal disease, or dental infection 3

Cause-Specific Treatment Algorithms

Dental Infection (Most Common)

• Refer immediately to a dentist within 24 hours for evaluation and possible extraction if gingival swelling, tooth mobility, or visible parulis is present 2
• Do not routinely prescribe antibiotics without dental evaluation, as swelling is often from mediator release rather than bacterial infection 2
• Systemic antibiotics are not routinely indicated for dental trauma unless the patient's medical condition requires coverage 2
• Follow up within 24-48 hours to ensure appropriate dental referral is completed 2

Acute Sialadenitis (Post-Surgical or Spontaneous)

• Recognize the stereotyped presentation: submandibular swelling beginning within 4 hours, typically contralateral to surgical site or unilateral in spontaneous cases 1
• Monitor closely for airway obstruction, the most feared complication requiring immediate intubation or tracheostomy 1
• Administer prolonged antibiotic therapy (beyond routine prophylaxis) in 68% of cases, though no bacterial superinfection has been documented 1
• Consider corticosteroids for airway swelling (used in 47% of reported cases) 1
• Promote salivary gland excretion with warm compresses, massage, and sialagogues 1
• Provide aggressive intravenous hydration to support recovery 1

Angular Cheilitis (Corners of Mouth)

• Apply combination antifungal-corticosteroid therapy to address both Candida infection and inflammation if swelling occurs at mouth corners with cracking 2
• Use white soft paraffin ointment every 2-4 hours for protection 2
• Reassess at 2 weeks; if no improvement, reevaluate diagnosis and patient compliance 2

Giant Cell Arteritis (Age >50 with Jaw Claudication)

• Initiate high-dose corticosteroids immediately (minimum 40 mg prednisone daily) within 2 weeks to prevent vision loss 2
• Obtain temporal artery biopsy if inflammatory markers are elevated 2

Hereditary Angioedema

• Administer specific on-demand medications including plasma-derived C1 inhibitor, icatibant (B2 bradykinin receptor antagonist), or ecallantide (plasma kallikrein inhibitor) as early as possible in the attack 1
• Avoid standard angioedema treatments (epinephrine, corticosteroids, antihistamines) as they have no significant effect 1
• Manage airway with close monitoring in a facility capable of intubation or tracheostomy for oropharyngeal/laryngeal attacks 1

Oral Mucositis (Chemotherapy/Radiation-Related)

• Clean the mouth daily with warm saline mouthwashes or an oral sponge 1, 4
• Apply white soft paraffin ointment to lips every 2 hours 1
• Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating 1
• Apply chlorhexidine antiseptic oral rinse twice daily 1
• Use potent topical corticosteroid mouthwash (betamethasone sodium phosphate) four times daily 1

Symptomatic Management

General Supportive Measures

• Apply cold compresses to reduce pain and swelling 1, 2
• Maintain oral hygiene with soft toothbrush or gentle oral sponge after meals 4
• Ensure adequate hydration by drinking ample fluids to keep the mouth moist 4
• Avoid irritants including smoking, alcohol, tomatoes, citrus fruits, hot drinks, and spicy foods 4

Critical Pitfalls to Avoid

• Never delay epinephrine administration in true anaphylaxis, as fatal reactions are associated with delayed treatment 1
• Do not use petroleum-based products chronically on lips, as they promote mucosal dehydration and increase secondary infection risk 4
• Avoid routine antibiotics for large local reactions as swelling is caused by allergic inflammation, not infection 1
• Do not prescribe potent narcotics (fentanyl patches, oxycodone) for outpatient use in recurrent conditions due to addiction risk 1

Uncommon Causes Requiring Specialist Referral

• Thyroid-associated orbitopathy presenting with bilateral premalar/cheek swelling (1.84% incidence in TAO patients), often with concurrent brow/eyelid swelling 5
• Primary extranodal non-Hodgkin lymphoma of the masseter muscle presenting as progressive facial asymmetry with paresthesia 6
• Ectopic parotid tissue causing chronic cheek swelling 7