Cicatricial contraction after severe burns may lead to marked deformities of the eyelids (ectropion), mouth, and nose. When the burn has implicated the neck, the chin may be drawn towards the chest, and the movements of the lower jaw and head seriously impeded.
Bacterial Disease.—Boils, carbuncles, and anthrax pustules frequently occur on the face, and when situated near the middle line, and particularly on the upper lip, are liable to give rise to general infection and to intra-cranial complications which may prove fatal. The primary infection of glanders and of actinomycosis may also occur on the face.
The various forms of tuberculous lupus are met with more frequently on the face than in any other situation ([Fig. 237]). Tuberculous disease of the facial bones, particularly of the lateral half of the orbital margin at the junction of the zygomatic (malar) bone with the maxilla, is not uncommon in children.
Fig. 237.—Illustrating the deformities caused by Lupus Vulgaris, which dated from adolescence.
(Mr. D. M. Greig's case.)
The primary lesion of syphilis, and the various forms of secondary and tertiary syphilides, may simulate tuberculous lupus, cancer, and other ulcerative conditions.
Tumours.—The simple tumours met with on the face include sebaceous and dermoid cysts, nævus, plexiform neuroma and adenoma; the malignant forms include the squamous epithelioma, and rodent, paraffin, and melanotic cancers.
Epithelioma occurs most frequently in men beyond the age of forty. The affection usually begins at the margin of the lip, the edge of the nostril, or the angle of the eye. There is generally a history of prolonged or repeated irritation, or the condition may develop in connection with a scar, a wart, a cutaneous horn, or an ulcerating sebaceous cyst. It may begin as a hard nodule, or as a papillary growth which breaks down on the surface, leaving a deep ulcer with a characteristically indurated base—the crateriform ulcer. The neighbouring lymph glands are infected early, but metastases to other organs are not common. The treatment consists in excising the growth and the associated lymph glands as early and as freely as possible. When excision is impracticable, benefit may be derived from the use of radium or of the X-rays.
The face is the commonest seat of rodent cancer (Volume I., p. 395).