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Download Sheet #14 / Dr.Yazan / Leen Farhan
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University of Jordan(2) Oral Medicine#14 Leen Farhan 12.2.2015 Faculty of Dentistry 4th year □Slides No. : □Sheet No. : Lecturer: Dr.Yazan Date:12/2/2015 Sheet’s Writer: Leen Farhan Lecture# : 14 (2) Price: Designed by Rawan Al-Majali Official website: jude20111.wordpress.com Leen Farhan Oral Medicine#14 (2) 12.2.2015 Today we're going to talk about lymphadenopathy and it's causes . You might face patients with neck swelling ,, this swelling has many differential diagnosis ; like masses related to glands ( thyroid and salivary ) or it could be a cyst ,, or due to a systemic disease or neoplastic . *** Lymph Node Enlargement *** : Could be due to : 1- cancer 2- infection ( both most common ) . Drainage of lymph nodes of head and neck manily to Submandibular L.N ,, Jugulodigastric L.N , and Deep Cervical L.N . and they can be easily examined and palpated . *** Infections of L.N*** : could be viral , bacterial or protozoal . 1-viral : URTI leads to swelling of jugulodigastric L.N We have also mumps , measles , herpes . 2-Bacterial : local causes like infection of skin , or apical abscess of cyst might lead to cervical L.N enlargement . or systemic infections like TB , syphilis , or cat scratch fever 3- Protozoal : toxoplasmosis . its rare . *** Glandular Fever ( Infectious Mononucleosis ) *** : Its common , sometimes undiagnosed , because it has mild symptoms , caused mainly by EBV ,, also caused by CMV , HIV , and Toxoplasmosis .. Clinical features : fever , malaise , weight loss , Cervical L.N enlargement , petechial patch of the palate (diagnostic feature of glandular fever) . splenomegaly and skin patches especially when taking an antibiotic , due to an allergic reaction even if the pt isn’t allergic to the antibiotic , but because the pt has viral infection . Also the lingual tonsils and foliate papilla can get inflamed and enlarged sometimes ,, the pt presents with enlargement of posterior border of the tongue and it’s bilateral . Diagnosis of Glandular fever depends on clinical features and the presence of abnormal lymphocytes in blood smear . also we can do serological tests ,, we'll find high liver enzymes and ESR . Leen Farhan Oral Medicine#14 (2) 12.2.2015 Bacterial infections that most commonly lead to cervical lymphadenopathy are dental infections , such as periodontial abscess ,, also due to TB , Syphilis ,, or cat scratch fever . ***cat scratch disease*** : bacterial infection ( bartonella ) ,, causes fever and cervical L.N enlargement ,, especially after contacting cats , self – limiting ,, and in some patients its sever so tetracycline is prescribed .. it causes caseating ( necrotizing) granuloma like TB . *** toxoplasmosis*** : protozoal infection caused by the parasite toxoplasma gondii , caused by consumption of incompletely cooked meat ,, symptoms are fever , malaise , cervical Lymphadenopathy , trt : tetracycline , diagnosis : serology test or toxoplasma . affects immunocompromised patients ,, rarely healthy indivisuals . *** Neoplastic causes of lymphadenopathy *** : Local tumor ( oral cancer of pharyngeal cancer ) , or metastasis of tumor , or primary tumor like lymphoma . Features : non – tender , hard , unlike infected L.Ns which are painful and soft . also it affects older patients , while infections affect young patients . ***Drug side effects *** : some drugs like phenytoin cause Lymphadenopathy . and also carbamazepine . ***Systemic diseases that cause lymphadenopathy *** : 1-Sarcoidosis 2-Systemic Lupus *** Sarcoidosis*** : granulomatous disease with non specific sings ,, usually diagnosed by chest x-ray ,,we'll see enlargement of pulmonary L.N ,, and also enlargement of cervical L.N .. Leen Farhan Oral Medicine#14 (2) 12.2.2015 *orofacial lesions of sarcoidosis : oral skin lesions : on the face , labial swelling and cobblestoning of the mucosa ,oral ulcers , hyperplastic gingivitis , dry eyes and mouth (angular chelitis) , vesicular lesions on the palate. *(Heerfordt syndrome) : uveitis , parotitis , fever and unilateral facial nerve palsy ,, found in advanced sarcoidosis patients . *Histology : non – caseating granuloma , langerhans giant cells , lymphocytes , and healing with scars . ***Developmental cuases of neck swellings *** : Mainly cysts ; branchial cyst , pharyngeal pouch , and lymphoepithelial cyst . There's a picture in the slides that shows a young patient with a fluctuant swelling in the neck , non tender ,, it could be neoplastic , but since its fluctuant and the patient is young , it'll be more of a cyst , filled with fluid . it's a branchial cyst . Sometimes we'll notice masses intraorally in the submental region , like the ranula sublingually , but when it appears in the submental space it's called plunging ranula .. but the differential diagnosis could be dermoid cyst and epidermoid cyst ( origin : skin appendages ) . Also some swellings in the neck are sebaceous cysts , that release pus or fluid , they cause lymphadenopathy due to dental infection . or it could be actinomycosis , that's characterized by an infection that forms pus in facial spaces with multiples sinus tracts . When a patient presents with a swelling ,, always ask about signs and symptoms , onset , duration , age , for example if a patient presents with cervical lymphadenopathy with fever , malaise, weight loss , cough , you'll probably think of TB , so always take systemic signs and symptoms into consideration. When examining the L.N , you have to know if the swelling is unilateral or bilateral , multiple or one swelling , because usually if there are multiple unilateral swellings , it's probably neoplastic , and if there's one swelling or multiple but bilateral , it's probably a viral infection. Also the size and texture of the swelling helps in diagnosis , Leen Farhan Oral Medicine#14 (2) 12.2.2015 as we said , if it's hard fixed non tender it's usually neoplastic, but if it's fluctuant soft and tender then it's usually infective . You might use additional investigations like taking a biopsy or aspiration of fluid ,, or MRI . In young patients , the swelling is usually due to an infection or drug side effects , rarely neoplastic , unlike adults who are more likely to have tumors . in cases of infections , we give the patient Antibiotics for 1-2 weeks and follow up , especially if there are no systemic diseases or neoplasia . GOOD LUCK Leen Farhan Oral Medicine#14 (2) 12.2.2015