Case Study: Submandibular Swelling

From a real case:

Patient:

Dear Dr,
I am a 28 yr old male. I have been under a lot of stress recently, and tend to rub the area under my jaw when stressed. I noticed on both sides three bumps there a while ago, all a little larger on the left. I assume they are lymph nodes and was not worried.
recently, on the left side, whatever I felt there was swollen more and I feel it now when I swallow and sometimes have a slight ache in the general area. I would say one of the structures is around a large pea or bean size. Are there any stuctures other than lymph nodes you can feel on the intersection of jaw/neck under the jaw and can repeated rubbing keep them swollen for a while? The largest one is moved around easily are more fleshy than firm but does not seem as smooth as before.
Under shiwch circumstances should I schedule an appoinment just for this?
Doctor:
Hello,
The submandibular lymph node drains the tongue, submaxillary gland, lips and mouth, conjunctivae. It can thus be enlarged due to infections of head, neck, sinuses, ears, eyes, scalp, pharynx. These are the most common causes, cancer being much less common.
From your description it appears that none of your lymph nodes are larger than 1cm in size. If they do not enlarge in size and no new lymph nodes appear and you do not develop symptoms such as hoarseness of vioce unexplained lymph node enlargement in cases that are not suspected of being at high risk of developing cancer are observed for 3 to 4 weeks.
Given the limitations of the internet, I am unable to rule out anything. I can only give you a very general impression which may infact be misleading. Under these circumstances I urge to seek medical attention as soon as possible.
Patient:

Dear Dr,

I have never used this site and I am simply amazed by the speed of your reply!! I fully understand the limitations of the internet.

I just wanted to know if manual irritation can lead to substantial node enlargement and if I could be confusing the bump with another structure in the area.

Doctor:

Hello sammy1,

Thank you for your kind words.

Manual irritation is not one of the causes of lymph node enlargement.

As for your second question: One of the criteria used to diagnose a lymph node enlargement is if a swelling occurs in a lymph node region. This is then easily confirmed by palpation.

Sometimes the situation is not so easy especially when it is present in a region where it can be confused with other structures (e.g. the supraclavicular lymph node – above the collar bone).

In your case there are very few structures in that region to confuse it with, so its more than likely that these are lymph nodes. Again, confirmation by clinical examination is warranted.

Patient:

Dear Dr,

just a follow up: I presented my symptoms (swollen node and slight pain when swallowing in the jaw/neck corner) to the GP.

She did not find any cause of infection and upon examination did not think there was anything unusual, as the bump was soft and mobile and in her assessment some, but not much enlarged.

She also said she is not completely sure it is a lymph node as in the far corner of the jaw there might be other palpable structures.

Even if it stays like this for a little while (without further significant enlargement of course), should I put this behind me?

Also, I did have an doppler ultrasound of that general area 7 month ago and nothing was noticed.

Again, thanks both for for swift replies and professionalism!

Doctor:

Dear sammy1,
I think you can safely put this behind you. As you say, should any new symptoms arise (such as further enlargement, new nodes) simply inform your GP so that s/he knows.
Congratulations!

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About LWJ

A doctor in Hospital Sultanah Aminah Johor Bahru (HSAJB).