Download Sheet #14 / Dr.Yazan / Leen Farhan

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)
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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