I guess I look slightly worse than the Elephant Man....

March 29, 2009 2:03 PM

My face is suddenly asymmetrical. Can the medically-inclined members of the Hive Mind give me ideas as to what may be the cause?

A little less than a year ago, it occurred to me when looking in the mirror that the left side of my face seemed to be slightly swollen in one area. Even though I've always had a "chubby" face, the right side of my face has a slight indentation between the "apple" of the cheek and the ear. Not so the left side. Just a few millimeters above the left earlobe and forward toward the left cheek "apple" (closer to the ear than to the cheek, though) there is a very slight (but still perceptible) bulge.

I mentioned this to my rheumatologist (who is also my GP) during my most recent appointment last January. She studied my face from a distance and stated "It is asymmetrical." She pressed along the area that appears to be swollen and commented that she couldn't feel any sort of mass there. She then said if it hadn't gone away on its own by my next appointment (June), she'd order either an X-ray or CT scan (I can't remember which) to see if there was "anything in there."

I've had lifelong sinus problems, along with Sjogren's Syndrome (one of the manifestations of my Lupus). The side of my face that is slightly swollen doesn't hurt, per se, but I am *aware* of it, if that makes any sense. If I happen to sleep on my left side for a long period of time, I'll still feel it after several hours after I've awakened and been out of bed. My left ear also often has a "full" sensation, and makes little popping noises (like Rice Krispies). My rheumy has gazed inside that ear and not found anything significant (not even excess wax). The only other "symptom" I can describe is that, after laying for a long time on my left side, I get a subtle but weird taste in my mouth - the best way I can describe it is a sort of baby food fruity taste, if that makes any sense.

Obviously, I'll most likely be undergoing further testing in a few months, but I wonder if anyone has any thoughts as to what this might be. When I press on the swollen area, I don't feel any pain. But, again, I do often feel a sensation of "fullness" on that side of my face. Any chance this could be some sort of sinus-y thing? But then again, what could make the face swell enough to be visibly obvious and yet the doctor can't feel anything when palpating it?

posted by Oriole Adams to health & fitness (10 answers total)

I had a schoolmate who suddenly had one side of his face slowly, painlessly atrophy, after a certain point it stopped but he's pretty asymmetrical now.
Are you sure you have swelling on one side, not shrinking on the other?
posted by dunkadunc at 2:36 PM on March 29, 2009

nb: Oriole asked about this last year as well - has there been any change?
posted by By The Grace of God at 2:45 PM on March 29, 2009

I sent you a MeMail.
posted by killdevil at 2:49 PM on March 29, 2009

Does your Sjogren's cause much trouble with dry mouth? And have you seen your dentist recently? [/wild ass guess]
posted by dilettante at 3:11 PM on March 29, 2009

I'm not a rheumatologist, but I believe it's fairly common for patients with Sjogren's to have parotid gland swelling/enlargement to the point that it's clearly visible in the mirror. As you likely know, Sjogren's attacks the exocrine glands of which the parotid is an example. This may be one explanation though there are many other things that can potentially cause this sort of facial asymmetry, including masses, cysts or duct obstruction within or around the parotid which may or may not be related to Sjogren's at all. CT, MRI, and ultrasound all have a potential role in figuring out what this might be attributable to so it sounds like your doc is on the right track and you should make sure to follow-up on this.
posted by drpynchon at 3:40 PM on March 29, 2009 [2 favorites]

It sounds to me as if you could possibly have a chronic Pseudomonas Aeruginosa infection.

It's often listed among the opportunistic infections that bedevil lupus sufferers.

It is a common cause of otitis media (middle ear inflammation) and apparently the most common cause of otitis externa.

It is the most common cause of respiratory infection in cystic fibrosis patients, who have thick mucus like you Sjogren's folks.

Mention of the parotids is interesting because human saliva apparently contains a peptide with strong activity against it.

And finally, it can be diagnosed by a characteristic sweet or fruity odor.
posted by jamjam at 5:27 PM on March 29, 2009

Oriole, just wanted to offer support in your lupus battle. My girlfriend has been a SLE sufferer for more than 15 years. Knowing what she goes through gives me compassion for you. As you may be aware, in the recent American Recovery and Reinvestment Act of 2009, Congress secured a significant funding increase of $10.4 billion for the National Institutes of Health (NIH), including for lupus research.
posted by netbros at 5:41 PM on March 29, 2009

Could it be swelling in and around your mandibular joint? If your bite is not symmetrical this can, over time, cause ear problems and swelling, along with other symptoms of TMJ (temporomandibular joint disorder) Do you grind your teeth at night?
posted by hellboundforcheddar at 7:31 AM on March 30, 2009

My first thought, before you mentioned lupus, was that it's a pleomorphic adenoma of the parotid gland. I had one and it presented EXACTLY like your issue. I suppose it's not improbable that there is no connection between this lump and your lupus, though, so I would suggest the possibility to your doctor. FYI, if it is a pleomorphic adenoma, the likely course of action will be to remove it surgically. If that ends up being your option, feel free to MeMail me. I had the surgery two years ago.
posted by cooker girl at 7:46 AM on March 30, 2009

Thanks to all for your input! Interestingly enough, cooker girl, both my mom and one of her sisters had some sort of surgery back when I was a kid to remove something from one of their parotid glands. I wonder if such a thing runs in families?

Hellbound, I do indeed clench my jaw and grind my teeth in my sleep. I also notice that when I sleep on my right side, my jaw seems to almost "sag," or not fit my bite right, if that makes any sense. I've occasionally woke myself up by clenching my jaw in this irregular fashion. Thanks for the helpful suggestion!

Netbros, thanks for your comment. I send good wishes to your GF and I hope she appreciates her understanding boyfriend (not a lot of partners are very patient with the many different symptoms/problems involved with Lupus.

Oddly enough, dilettante, my Sjogren's affects mainly my nose and sinuses and my eyes to a lesser degree. But I've never had a problem with dry mouth, and in fact tend to drool (a lot) in my sleep. Go figure. I did get more than the usual amount of cavities as a child, enough that my dentist gave me this weird "spit test" to take and then put me on a very restricted diet for a few months. When I mentioned this to my rheumy 20-some years later, he theorized that my dry sinuses were causing me to breathe through my mouth at night, which could've caused the excess cavities. I still have the same sinus/breathing problems as an adult, but Sudafed and saline nasal sprays have come on the market since the time when I was in the third grade.

Again, many thanks for everyone's input!
posted by Oriole Adams at 2:17 PM on March 30, 2009