Thursday, October 30, 2014

Submandibular Lymphadenopathy

Definition

Submandibular lymphadenopathy refers to enlarged lymph nodes located beneath the mandible (lower jaw).

Description

Hot, swollen, tender, supple lymph nodes usually indicate infection and are accompanied by other symptoms. Infectious nodes are frequently swollen, hot, tender, and accompanied by constitutional symptoms (fever, fatigue, muscle aches).

Epstein-Barr virus, cytomegalovirus, cat-scratch disease, tuberculosis, sexually transmitted diseases, and bacterial infections are among the most common diagnoses to be considered. Bacterial endocarditis can cause lymphadenopathy and is characterized by fever, history of IV drug use, or known heart valve disease.

Causes

Noncarcinogenic and noninfectious illnesses such as drug-induced lymphadenopathy, collagen vascular disorders, and sarcoidosis may also cause generalized or localized adenopathy. While nearly any drug can spur a reaction in the lymph nodes, phenytoin sodium (Dilantin) is a common cause. Peripheral lymphadenopathy is common in asymptomaticsarcoidosis, which frequently becomes evident on biopsy.

Fixed, hard, unilateral (one side of the body) nodes can signal cancer.

Symptoms

The location of enlarged nodes is a powerful key to sorting out possible causes and determining a course of action.

Palpable (able to be felt) nodes on the side of the neck are usually benign and often infectious, but a history of smoking or chewing tobacco may cause concern about cancer.

Small, "shotty" nodes, named because they feel like lead pellets (shot), are common and can be followed without evaluation.

Abnormal nodes in the supraclavicular (above the collarbone) area suggest cancer and are candidates for early biopsy regardless of size.

Diagnosis

In general, the presence or absence of other signs and symptoms, changes in the nodes over time, and the characteristics of the nodes themselves determine how assertive any diagnostic plan should be.

For example, a patient with a movable, stable, soft node in the neck who is otherwise healthy can be observed for months. On the other hand, hard axillary (armpit) or supraclavicular (above the collarbone) nodes raise the suspicion of cancer and require aggressive biopsy (a procedure to sample lymph node tissue).

If adenopathy is chronic in one area, a thorough physical examination will determine if other less obvious nodes are involved, and palpating the liver and spleen may help determine the extent of involvement, particularly significant in lymphoma. Persistent, generalized (throughout the body) lymphadenopathy with no other signs is unusual and requires testing.

Treatment

Because many illnesses can cause adenopathy, the management can range from an immediate surgical consultation to noninvasive testing to observation for a 3 to 6 month period, depending on the patient's medical history and physical findings.

Questions

What is the extent of node enlargement?

Are the nodes tender or firm?

What is the probable cause?

Is there evidence of infection?

Should a biopsy be done?

What further tests do you recommend?