What does this mean?
The two sides are not expected to be exactly alike. Small differences in the size of the eyes, the height of the eyebrows and the jawline are present in most people and can be seen in old photographs too. That is why the real question at an assessment is this: has this difference been there for years, or has it appeared in the last few weeks?
Two separate kinds of asymmetry are distinguished. The first is a difference in volume: one cheek, one jaw edge or the area in front of one ear looks fuller than the other, and the difference is obvious even when the face is still. The second is a difference in movement: the face looks similar at rest, but the two sides do not move in the same way when you smile, raise your eyebrows or close your eyes tightly. This distinction is the first step in separating a nerve-related picture from the others.
How fast the change happens carries information as well. A swelling that grows within hours and is hot, red and painful suggests a spreading infection. A painless fullness that grows quietly over months may be a growth inside the bone or a lump arising from a gland. A change that has been going on in the jaw joint for a long time, meanwhile, can slowly shift your bite and the position of your chin.
New facial asymmetry cannot be put down to a single cause; infection, a growth inside the bone, a salivary gland problem, a change in the jaw joint and involvement of a nerve can all produce a similar appearance. The headings below are the possibilities this distinction is made between.
Likely causes
What helps at home?
- Look at your old photographs and try to work out how long the difference has been there; this is the first question asked at an examination, and only you have the answer.
- Smile in the mirror, raise your eyebrows and close your eyes tightly; note any difference that shows up during movement separately from a difference you can see at rest.
- If there is a swelling, do not press on it, apply heat to it or try to drain it; these attempts can make it easier for the infection to spread to neighbouring areas.
- Do not start treating yourself with antibiotics you have left over; medication used before the source has been found can mask the picture and delay the assessment.
- The swelling is growing within hours, you have a fever, or you are having trouble swallowing
- The swelling has spread towards your eyelid, or you are having trouble opening your mouth
- One side of your face has dropped, you cannot close your eye fully, or your speech has become slurred
- Numbness has started in your face, your lip or your chin
- You took a blow to the jaw and your teeth have been meeting differently since that day
Frequently asked questions
- How quickly should the asymmetry in my face be looked into?
- Small differences that have stayed the same for years are taken as ordinary and usually need nothing done about them. A difference that has appeared or become more obvious in the last few weeks, on the other hand, should be assessed without putting it off. If it comes with a fever, rapid growth, numbness or loss of movement, you need to be seen the same day; these are not findings to watch in the hope that they will settle on their own.
- What imaging is done for facial asymmetry?
- The assessment starts with an examination. If a cause in the teeth or the jaws is suspected, a panoramic X-ray is taken, and cross-sectional imaging is requested if needed. If a lump arising from a salivary gland or from the soft tissue is suspected, you are referred to oral and maxillofacial surgery or to ear, nose and throat for an ultrasound scan and further imaging. Which investigation is needed is decided by the findings on examination.
- Does chewing on one side make the face asymmetrical?
- Chewing on one side for a long time may lead the chewing muscle on that side to develop a little more, and this can show as slight fullness at the angle of the jaw. It would not be right, however, to explain a difference that is new, growing fast or coming with pain by this habit. A change like that should be assessed separately and without delay.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.