Medical Emergencies · patient case question
What is the MOST appropriate immediate management?
Patient case: Spreading swelling of the upper face
Patient: 37-year-old man, emergency appointment.
Chief complaint: My face is swelling and it is getting worse quickly.
History: Two days of increasing swelling that began around an upper tooth. Now feels feverish and unwell.
Findings: Diffuse, firm, warm, erythematous swelling of the right upper face extending toward the medial canthus and lower eyelid. No fluctuance. Temperature 38.6°C. Grossly carious maxillary tooth with periapical tenderness.
Show answer and explanation
Correct answer: B. Refer urgently to the emergency department for admission and intravenous antibiotics
- A. Incision and drainage is for a LOCALIZED fluctuant collection. There is no drainable pus here, and cutting into the danger triangle risks worsening spread.
- B. CORRECT. Rapidly spreading facial cellulitis with fever and periorbital involvement threatens the orbit and the cavernous sinus. This needs hospital admission, intravenous antibiotics, and source control. Definitive extraction or drainage of the offending tooth follows once the patient is stabilized.
- C. Topical antibiotics have no role in a deep spreading soft tissue infection.
- D. An oral antibiotic with a one-week review dangerously under-treats a febrile, rapidly progressing infection near the orbit.
Practice Medical Emergencies questions Medical Emergencies study notes