Buccal Cellulitis

Aka: Buccal Cellulitis, Cellulitis of External Cheek

1. See Also
   1. Facial Erysipelas
2. Epidemiology
   1. Relatively rare in the U.S. due to Hib Vaccine and Pneumococcal Conjugate Vaccine
   2. Age <5 years old (esp. <12 months of age)
3. Causes
   1. HaemophilusInfluenzae Type B (most common cause, esp. pre-Hib Vaccine era)
   2. Streptococcus Pneumoniae
4. Symptoms
   1. Prodromal symptoms (onset up to 8 hours before rash onset)
      1. Coryza
      2. Fever
5. Signs
   1. Significant cheek swelling accompanied by erythema and purple discoloration of the malar region
   2. Mild Trismus
   3. Low grade fever
6. Differential Diagnosis
   1. See Malar Rash
   2. Facial Erysipelas (Group A Streptococcal Cellulitis)
      1. Focal area on face of Paresthesia or pain, followed by rash developing, often in malar distribution
      2. May be preceded by Pharyngitis
   3. Staphylococcus aureusCellulitis
      1. On the face, Staphylococcal Cellulitis may be indistinguishable from streptococcal Erysipelas
   4. Parvovirus B19 (Fifth Disease)
      1. Facial erythema (slapped cheek appearance) spares the chin and periorbital region
   5. Dental Abscess extension
   6. Wells’ syndrome
      1. Eosinophilic Cellulitis
7. Management
   1. See Facial Erysipelas
   2. Exercise caution in the post-Hib Era with Buccal Cellulitis and consider management as Facial Erysipelas
   3. Buccal Cellulitis was historically treated to cover for HaemophilusInfluenzae Type B
      1. Ceftriaxone 50 mg/kg IV every 24 hours has been used for severe infections
      2. Trimethoprim Sulfamethoxazole (Septra, Bactrim) has been used for oral antibiotic management
8. Prevention
   1. See Hib Vaccine
   2. See Pneumococcal Conjugate Vaccine
9. References
   1. (2019) Sanford Guide, accessed on IOS 11/20/2019
   2. Walker (1990) Am J Emerg Med 8(6):542-5 [PubMed]