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FACE SYMPTOMSRecognize the patient needing urgent attention:• Possible stroke/TIA: sudden onset of one sided facial weakness with minimal or no involvement of the forehead usually with weakness of arm/leg 76.• Facial swelling and difficult breathing: check urine dipstick:--Abnormal urine dipstick: kidney disease likely--Normal urine dipstick: anaphylaxis likely: give adrenaline 1 1ml (1:1000) IM every 5 minutes until better and hydrocortisone 100mg slow IV and promethazine 50 mg IM/slow IV• Painful facial swelling and temperature ≥ 38°C: facial cellulitis likelyRefer urgently same day.Approach to patient with facial symptoms not needing urgent attentionFace pain Sudden weakness of 1 side of face Swelling of facePain of cheek or jaw with/withoutswelling and on tapping involved toothGum/tooth infection likely• Give paracetamol 1g 6 hourly• Give amoxicillin 500mg 8 hourlyfor 5 days. If penicillin allergic, giveerythromycin 500mg 6 hourly for 5days and metronidazole 400mg 8hourly for 5 days.• Refer to dentist same week.Pain over forehead or cheek/s worse onbending forwards and/or pressure oversinuses and/or purulent nasal or postnasal dischargeSinus infection likely• Give paracetamol 1g 6 hourly• If symptoms for > 6 days, giveamoxicillin 500mg 8 hourly for 5 days.If penicillin allergic, give erythromycin500mg 6 hourly for 5 days.• Salt water washes or steam inhalationmay relieve symptoms.• Refer if:--Associated tooth infection--Poor response to treatment--Swelling over sinus or around eye--Meningism--If sinusitis is recurrent and statusunknown test for HIV 60.--Recurrent sinusitis is a stage 2 HIVdiagnosis. Patient needs routineHIV care 61.Unable to wrinkle forehead;cannot close eye fullyIdiopathic (Bell’s) palsy likely• Rarely may be painful.• Sagging mouth, dribbling, tasteimpairment, watering or dry eyes• Patient cannot wrinkle forehead, blowforcefully, whistle or pout out cheek.• Protect eye by closing eyelid withsurgical tape if cornea is exposed.• Reassure patient that most peoplerecover completely within 10 days.• Refer if:--No improvement after 10 days--Patient has otitis media--Any change in hearing--Recent head trauma--Damage to cornea--Unsure of diagnosisEnsure patient has no difficultbreathing, RR < 30, otherwise manageurgently as above.Is patient on enalapril?YesPatient hasangioedema andmust stop enalapriland never start itagain.• Givechlorpheniramine4mg 8 hourly for1–2 days untilswelling resolved.• Refer to doctorfor review ofmedication.• Advise patient toreturn urgentlyshould difficultbreathing occur.NoRefer to doctorfor review.1Adrenaline is also known as epinephrine.11