title: Prominent premalar and cheek swelling: a sign of thyroid-associated orbitopathy.
abstract: OBJECTIVE
  To describe prominent premalar and cheek swelling as a previously undescribed clinical feature of thyroid-associated orbitopathy (TAO).
  
  
  METHODS
  Retrospective interventional case series.
  
  
  METHODS
  A retrospective case review of patients with prominent premalar and/or cheek swelling and TAO was undertaken. All patients who presented from March 2002 to February 2005 with complaints of premalar and/or cheek swelling in TAO were analyzed.
  
  
  RESULTS
  Six female patients between the ages of 28 and 66 years (average, 44.2 years) who had complaints of prominent premalar and/or cheek swelling and TAO were included in the study, among 326 new patients with TAO (incidence: 1.84%). Five of the 6 patients had Graves hyperthyroidism. One initially had Hashimoto thyroiditis, which converted to Graves hyperthyroidism. In all cases, TAO preceded the thyroid disease or developed simultaneously (average time from TAO to thyroid disease was 3.0 months). No patient had received corticosteroids before premalar and/or cheek swelling. The premalar and/or cheek swelling was bilateral in all cases, but 2 of 6 were asymmetric. No diurnal fluctuation or tenderness in premalar and/or cheek swelling was noted. All improved incompletely over several months. Brow, eyelid swelling, and orbital-fat hypertrophy on radiologic examination was coincidentally noted in 5 of 6 cases. Pretibial myxedema was noted in one case. One case was associated with another autoimmune disease (rheumatoid arthritis).
  
  
  CONCLUSIONS
  Prominent premalar and cheek swelling should be considered among the clinical features of TAO. The true incidence will become apparent as we question and examine patients more carefully regarding this entity and as we review premorbid photographs.
authors.affiliation: Department of Ophthalmology, New York Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Byoung Jin
authors.initials: BJ
authors.lastname: Kim
authors.forename: Michael
authors.initials: M
authors.lastname: Kazim
mesh_terms: D000328:Adult; D000368:Aged; D002610:Cheek / Q000473:pathology*; D003937:Diagnosis, Differential; D004487:Edema / Q000209:etiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000150:complications / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015050:Zygoma / Q000473:pathology*