FACES syndrome
Overview
A rare syndrome characterized mainly by short stature, webbed fingers and toes and skeletal abnormalities.
Symptoms
* Kyphosis * Freckles * Sunken chest * Retinal anomaly * Scoliosis * Thyroid anomaly * Abnormal voice * Flat foot * Droopy eyelid * Short stature * Webbed fingers * Webbed toes * Muscle problems * Poor muscle build * Anteverted nostrils * Asymmetrical rib cage * Cafe-au-lait spot
Causes
This type of abscess, which usually results from poor oral hygiene, is commonly caused by anaerobic organisms. It can cause edema of the side of the face, pain, warmth, erythema, and a purulent discharge around the affected tooth. TopAbscess, peritonsillar This complication of tonsillitis may cause unilateral facial edema. Other key signs and symptoms include severe throat pain, neck swelling, drooling, cervical adenopathy, fever, chills, and malaise. TopAllergic reaction Facial edema may characterize both a local allergic reaction and anaphylaxis. A local reaction produces facial edema, erythema, and urticaria. In life-threatening anaphylaxis, angioneurotic facial edema may occur with urticaria and flushing. (See Recognizing angioneurotic edema.) Airway edema causes hoarseness, stridor, and bronchospasm with dyspnea and tachypnea. Signs of shock, such as hypotension and cool, clammy skin, may also occur. TopCavernous sinus thrombosis Cavernous sinus thrombosis is a rare but serious disorder that may begin with unilateral edema that quickly progresses to bilateral edema of the forehead, base of the nose, and eyelids. It may also produce chills, fever, headache, nausea, lethargy, exophthalmos, and eye pain. TopChalazion A chalazion causes localized swelling and tenderness of the affected eyelid, accompanied by a small red lump on the conjunctival surface. TopConjunctivitis
Diagnosis
The first thing to determine is whether there is an infectious or neoplastic process in the structures underlying the face. X-rays of the sinuses and teeth and CT scans of the sinuses and brain may be necessary to further elucidate this. An x-ray of the temporomandibular joint may be helpful. An MRI of the temporomandibular joint is the procedure of choice to rule out pathology of this joint. Referral to a dentist to evaluate the patient's teeth or to an ear, nose, and throat specialist to evaluate sinusitis may be necessary. To rule out cluster headaches or atypical migraine, a histamine test may be done. It may be wise to see the patient during an attack so that superficial temporal artery compression can be done to rule out migraine and/or a shot of sumatriptan succinate can be given, which should provide immediate results in cluster headache and atypical migraine. A trial of carbamazepine (Tegretol®) can be given in cases of suspected trigeminal neuralgia, but referral to a neurosurgeon for an alcoholic injection of the maxillary or mandibular branches of trigeminal nerve will more likely make the diagnosis and solve the patient's problem.