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INTRODUCTION

This chapter will discuss facial infections and disorders involving the mandible. Bell’s palsy is discussed in Chapter 172, “Acute Peripheral Neurologic Disorders.” Trigeminal neuralgia is discussed in Chapter 38, “Chronic Pain.” Nonfacial cellulitis and erysipelas are discussed in Chapter 152, “Soft Tissue Infections.” Impetigo in children is discussed in Chapter 142, “Rashes in Infants and Children.” Orbital cellulitis is discussed in Chapter 241, “Eye Emergencies.”

FACIAL CELLULITIS, ERYSIPELAS, AND IMPETIGO

The differential diagnosis of facial infections is provided in Table 243-1.1

TABLE 243-1Differential Diagnosis of Superficial Facial Infection

CELLULITIS

Cellulitis is a superficial soft tissue infection that lacks anatomic constraints.2-4 Facial cellulitis is caused most commonly by Streptococcus species,5 including Streptococcus pyogenes (group A β-hemolytic) and group G Streptococcus, and Staphylococcus aureus,4 with an increasing predominance of methicillin-resistant S. aureus.6 An important consideration for facial cellulitis is the potential for an odontogenic source of the infection in the midface. Anaerobic bacteria account for 24% to 62% of the odontogenic infections.4,7 Methicillin-resistant S. aureus is the most common cause of purulent cellulitis, identified by purulent drainage, purulent bulla, or suspected abscess.3 Methicillin-resistant S. aureus also is suspected when risk factors are present (see Chapter 152, “Soft Tissue Infections”). Less commonly, cellulitis may represent extension from deep space infections (see “Masticator Space Infection” section later in this chapter). Bedside ...

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