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Old 12-21-2003, 02:39 PM   #1
Hi_its_Joe
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Unhappy Nodes under jaw sore and swollen - (scared!)

Good evening (I apologize for the length of this post)

I've always had a slightly enlarged lymph node under my jaw on the left side which the doctor told me (yesterday at the ER) was probably either from my sinusitis/rhinitis or from an early childhood infection that caused the node to become blocked (which according to her is harmless and common).

My main concern right now is that the lymph nodes under my jaw going from one side to the other are swollen and sore. Mind you, they are not "huge" but they are definately swollen and I can't remember them ever being that way before and it is scaring me )-: .

I have no idea why they would suddenly swell over the last 3-4 days but the only possabilities I can come up with are the following...

1) I'm an ex-tobacco chewer with a small white-ish patch on my gum who chewed smokeless tobacco for 20 years but quit 5 days ago and went on nicotine gum. The doctor said she did see leukoplakia but my nodes were "unremarkable" and she did'nt see any tumors, malinancies or other "red flags". She lined me up to see an ENT next week for a possible biopsy. Could my nodes be swelling due to oral cancer?.

2) It is cold/flu season here and I am told that there are "lots" of things going around. Could this simply be a virus or something?

3) I got an injection of novacain when I had a tooth pulled. the dentist was extremely rude and insulting and even broke the law while I was there (long story). His uncruptulous and unethical behavior makes me wonder if he would re-use syringes just to save a buck or two - perhaps why I have swollen nodes now (although it's been a month or more since I saw him).

4) An infected/impacted tooth can cause this sort of thing (I read) and I do have a lot of cavities. In fact, every time I go to the doctor, he reminds me that I really need to start taking better care of my teeth. Honestly, I hav'nt brushed them in probably 20 years or so because I chewed tobacco and felt that it was pretty useless since they would only get "dirty" again. I'm also missing quite a few teeth and the ones I have left are pretty much ground down (hint: I don't think you would want to kiss me).

5) Upon discovering that I had one or more white patches (leukoplakia) in my mouth and being a chewer for 20 years, I became increasingly paranoid about oral cancer and so I read a lot about it and found out that having it can cause "an impairment in jaw movement". After reading this, I developed this habit of moving my jaw back and forth in a scissor-like motion every so often just to "test" wether I had any of the "jaw impairments" I had read about. This, I believe, is when I really started to get some pain and soreness in my jaw region but I thought only infection and cancer could cause swollen nodes rather than just movement...hmmm.

6) Prior to all of this ocurring (and perhaps it's just coincidence), I had taken Celexa (10mg per day) for the better part of a week (I did have a lot of side affects).

7) I suffer from acute sinusitis and allergic rhinitis but this has never really caused any swelling in my lymph nodes (that I've ever been aware of anyway). Could this be the reason my nodes under my jaw/chin are swollen?.

These seven (7) things are all that come to mind and I'm not sure if any, all or a combination of them could cause the lymph nodes under my jaw to become moderately sore and swollen. Again, they are not huge, hot to the touch, red, etc and there is no "tracking". My temp as of the last 3-4 days has been around 98.2-98.6. My BP has been normal as has my appetite, stools, energy-level, motivation, etc. I don't really have any symptoms other than the swollen nodes. The ER doctor I saw yesterday shook her head and said "nah, I don't think so" when I asked her if she thought I had TMJ but I'll let you good people be the judge.

As a side note, I HAVE had a small, pea-sized lymph node swelling behind my left ear that has ocurred maybe once every month or so for many years. It only ocurrs on the left side and I have no idea what this means. They are not rock-hard and they are not getting any bigger (or smaller). They are pea-sized or less right now (the ones under my jaw). I don't have swollen lymph nodes anywhere else at the moment.

Anyway, I realize this is pretty long and I apologize for that. I would really appreciate any input on this situation and what is most likely causing it. I have been freaking over this for a week now and hopefully someone can tell me what this sounds like, if it's prety common, if they've experienced this themselves, etc, etc.

Thank you (more than you could ever realize!!)

Last edited by Hi_its_Joe; 12-21-2003 at 02:46 PM.

 
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Old 12-21-2003, 04:53 PM   #2
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Re: Nodes under jaw sore and swollen - (scared!)

Hi Joe,

I haven't been coming to these boards as frequently as I was in the past few months due to other obligations, but I see you've made quite a few posts in the past week or two about this, both here and in other forums. I'm going to try to answer as much as I can so that maybe I can give you some information (it looks like you haven't been getting a lot of responses), but please keep in mind that ENT is not my area of expertise. I can also see that you've done a lot of research on your own with this, so rather than try and guess what you do and don't know, I'll treat it as if it's all new to you (there will undoubtedly be some stuff you already know, but maybe I'll hit on some new things for you).

First, it's important to understand why your lymph nodes might swell in the first place. I kind of think of lymph nodes as the train stations of your immune system. In the simplest definition, lymph nodes are structures found all over the body that receive, process, and send out lymph. They are connected by lymphatic vessels (like very tiny blood vessels) that connect one node to another. Lymph, by the way, is simply a clear, watery fluid that contains white blood cells, protein, and loose extracellular debris. One function of the lymphatic system is to collect all of the loose debris and fluid that accumulates outside of the cells of your body (this is general wear-and-tear debris). Probably the most important function of a lymph node is that it houses white blood cells (defend the body against pathogens) and macrophages (cells that eat up those pathogens and subsequently alert the WBCs that they need to start going to work). When a pathogen enters the body, it will usually end up in the lymphatic system (due to it's housecleaning function in the body). When a pathogen is attacked by a macrophage and presented to a white blood cell, each of these cell types symbiotically stimulates the other to multiply within the lymph node. This allows your body to quickly develop an army of WBCs and macrophages to fight the incoming infection. This is also how/why your lymph nodes swell up during an infection.

There are a couple of other reasons your nodes might swell. Sometimes people develop cancer within the lymph nodes themselves (lymphoma, which is actually a cancer of the WBCs within the nodes - contrast this with leukemia, which is cancer outside the nodes). Other times, the lymph node is invaded by a metastatic cancer (as you probably know, most cancers can become metastatic and travel to other organs - just like a cancer can go to the liver or lungs and take up residence there, they can also go to the lymph nodes). Rarely, I've heard of drug interactions causing nodal swelling, but this is not very common.

There are three nodes that are found under the jaw - tonsillar, submandibular and submental. Tonsillar nodes are found at the back edge of the jaw, inferior to the bone on either side. Submandibular are found midway between tonsillar nodes and the tip of the chin, again inferior to the jaw bone (the mandible - hence, submandibular). Submental is found about 3 cm behind the tip of the chin in the midline. Basically, the flow of lymph is such that everything in the head ends up one of these three nodes (commonly submandibular) and goes to the cervical nodes of the neck.

So let's think about each of your ideas and consider the likelihood of each.

Quote:
Originally Posted by Hi_its_Joe
I have no idea why they would suddenly swell over the last 3-4 days but the only possabilities I can come up with are the following...

1) I'm an ex-tobacco chewer with a small white-ish patch on my gum who chewed smokeless tobacco for 20 years but quit 5 days ago and went on nicotine gum. The doctor said she did see leukoplakia but my nodes were "unremarkable" and she did'nt see any tumors, malinancies or other "red flags". She lined me up to see an ENT next week for a possible biopsy. Could my nodes be swelling due to oral cancer?.
First, the really good news is that there was no obvious tumor or malignancy. I'm sure you know from your own research that leukoplakia is a white plaque-like lesion that is not a cancer (or even a tumor), but predisposes you to oral cancer. If my memory serves correctly, the risk of conversion to malignancy is only about 2% over a twenty year period with leukoplakia, versus 50% with erythroplakia (a much more aggressive version of leukoplakia). The three most common causes are, in order, tobacco chewing, tobacco smoking, and alcohol.

Although leukoplakia has an association with cancer, it really is only an oral lesion. It is not a tumor and it is not an infection. If they did not find any tumors and they are sure of that, the leukoplakia alone would not cause any nodal swelling. I didn't exactly answer your question though - yes, oral cancer can cause the nodes you described to swell. Assuming the ENT was right and that you do not have any oral tumors, this would be low on my differential list of causes for your nodal swelling.

Quote:
Originally Posted by Hi_its_Joe
2) It is cold/flu season here and I am told that there are "lots" of things going around. Could this simply be a virus or something?
Absoultely. This is very likely and would be high on my differential list.

Quote:
Originally Posted by Hi_its_Joe
3) I got an injection of novacain when I had a tooth pulled. the dentist was extremely rude and insulting and even broke the law while I was there (long story). His uncruptulous and unethical behavior makes me wonder if he would re-use syringes just to save a buck or two - perhaps why I have swollen nodes now (although it's been a month or more since I saw him).
Nah, doesn't sound likely at all. Even if he did reuse syringes (which is risking his entire practice and future income), that wouldn't really account for nodal swelling unless you picked up an infection. Still, this doesn't sound likely at all. I'd rank this last.

Quote:
Originally Posted by Hi_its_Joe
4) An infected/impacted tooth can cause this sort of thing (I read) and I do have a lot of cavities. In fact, every time I go to the doctor, he reminds me that I really need to start taking better care of my teeth. Honestly, I hav'nt brushed them in probably 20 years or so because I chewed tobacco and felt that it was pretty useless since they would only get "dirty" again. I'm also missing quite a few teeth and the ones I have left are pretty much ground down (hint: I don't think you would want to kiss me).

Sure, I'll go with you on this one. I'm not a dentist, but I certainly agree that an infected tooth can cause nodal swelling in the areas you've described. Remember, ANY infection above above the neck can cause those nodes I talked about to swell up. Again, I'm no dentist, but I'd imagine you'd have to have a pretty bad infection; but yes, this is a possibility too.

Quote:
Originally Posted by Hi_its_Joe
5) Upon discovering that I had one or more white patches (leukoplakia) in my mouth and being a chewer for 20 years, I became increasingly paranoid about oral cancer and so I read a lot about it and found out that having it can cause "an impairment in jaw movement". After reading this, I developed this habit of moving my jaw back and forth in a scissor-like motion every so often just to "test" wether I had any of the "jaw impairments" I had read about. This, I believe, is when I really started to get some pain and soreness in my jaw region but I thought only infection and cancer could cause swollen nodes rather than just movement...hmmm.
Yeah, the movement itself can cause some pain - might be a good idea to try not to do that if you can, since there are some nerves located at the joint that you don't want to damage. And yes, oral cancers CAN cause jaw problems, although this is certainly not the first or most characteristic sign. What the ENT is going to look for (i.e. the classic signs) is ulcerations, lumps, changes in color - oral cancers tend not to present (at least initially) as the big and bulky kind that you find in GI or lung. A couple of other things about oral cancers that you may find noteworthy: As is discussed above, cervical nodal enlargement is most commonly seen. If untreated, the cancer can spread; the pattern is generally first to the front of the neck and then to lung, bone, liver, etc. Also, in addition to the similar risk factors noted above for leukoplakia, poor dentition is a strong risk factor.

Again, given what you've told us, I really think this is premature. I cannot honestly say that this is low on my list of suspicions, but I also can't say it's very high. Given that the ENT did not appreciate any tumors, it does not seem a likely source of a submandibular nodal enlargement. If you had massive cervical enlargements as well, my suspicion would be raised even more, but...well, you don't!

Quote:
Originally Posted by Hi_its_Joe
6) Prior to all of this ocurring (and perhaps it's just coincidence), I had taken Celexa (10mg per day) for the better part of a week (I did have a lot of side affects).
Nah - celexa has a lot of side effects, but nodal enlargement is not one of them. Scratch what I said earlier, I'd rank THIS last and your dentist reusing syringes second to last.

Quote:
Originally Posted by Hi_its_Joe
7) I suffer from acute sinusitis and allergic rhinitis but this has never really caused any swelling in my lymph nodes (that I've ever been aware of anyway). Could this be the reason my nodes under my jaw/chin are swollen?.
This is a pretty good possibility too. Remember, anything ending with an -itis means infection. You'll recall that any infection can (not will, but can) lead to an immune reaction that leads to nodal swelling.

Last edited by fudd; 12-21-2003 at 05:23 PM.

 
Old 12-21-2003, 04:54 PM   #3
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Join Date: Oct 2003
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Re: Nodes under jaw sore and swollen - (scared!)

Heh - went over the 10K character limit, so I had to break it up.

Quote:
Originally Posted by Hi_its_Joe
The ER doctor I saw yesterday shook her head and said "nah, I don't think so" when I asked her if she thought I had TMJ but I'll let you good people be the judge.
I agree with the ER doc, and pretty strongly at that. TMJ just doesn't present with anything that you're describing, except for the joint pain. One symptom in favor of and multiple symptoms against is not a very democratic diagnosis, if you see what I mean.

Quote:
Originally Posted by Hi_its_Joe
As a side note, I HAVE had a small, pea-sized lymph node swelling behind my left ear that has ocurred maybe once every month or so for many years. It only ocurrs on the left side and I have no idea what this means. They are not rock-hard and they are not getting any bigger (or smaller). They are pea-sized or less right now (the ones under my jaw). I don't have swollen lymph nodes anywhere else at the moment.
Remember, even if you don't have symptoms, you are always infected with SOMETHING. Your body is working 24/7 against infection. It is common to have swollen nodes from time to time with not even a single other symptom. The nodes you are referring to are called posterior auricular nodes and can swell for any of the reasons discussed above. Many people experience random nodal swelling like this. When you are talking multiple nodal swelling, or very, very large swelling, it might be a sign of something more serious (I've frequently seen posteriour auricular swelling with mononucleosis, but they were some honkin' lymph nodes - I mean 2-3 times the size of a marble).

So there is my opinion, which - please realize - can only be an opinion without the luxury of physical exam results, labwork, etc. ENTs see this stuff day in and day out, and I'm very confident that you will get to the bottom of this with your doctor. Over the internet, though, if I were to take a stab at, I'd say you have some sort of a low-lying infection right now that is coincidentally occurring at the same time you have noticed the leukoplakia. Tell me that they found tumors (even small ones) in your mouth, tell me that you've also noticed huge cervical (neck) lymph nodes, and I may have a different take on it. Until then, great move on quitting the tobacco. Please keep us updated on what the ENT says. Sorry this was so long (and possibly a bit boring - most people don't like medical background, they just want answers, but I get carried away sometimes). I can see you're really concerned and I wanted to give as much info/input as I could.

And also - have a great holiday, this will all get resolved.

Last edited by fudd; 12-21-2003 at 05:29 PM.

 
Old 12-21-2003, 07:38 PM   #4
Hi_its_Joe
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Re: Nodes under jaw sore and swollen - (scared!)

Wow Fudd, I don't even know where to begin except to extend my heartfelt appreciation to you for the extent to which you addressed my issues and concerns. Your reply was was articulate, thorough, well-balanced, intelligent, professional and very helpful!. One thing is certain; you are definately very knowledgable and are to be commended for your willingness to selflessly assist others on this board (including myself) the way you have. Now perhaps that sounds a bit mushy but I'm just VERY greatful and it's the truth. You certainly know considerably more that I do!:-).

Anyway, I wanted to mention that since I've started on the smoking cessation adjunct (ie; the gum) and ceased chewing over the past 4 days, I have begun to notice a gradual (but significant) decrease in the size of the leukoplakia (pl?). I'm going to guess that this is a good sign Also, at this time I do not have any of the inflamed red patches characteristic of the more aggressive erythroplakia that you mentioned (also a good sign I'm hoping/guessing). The location of my leukoplakia and thier status are as follows...

1) Lower-left region of jaw directly over the spot where I had a wisdom tooth extracted over 20 years ago. Over this area is a small, slightly wrinkled opaque-white patch approximately the diameter of a baby sweet pee with a border that is not particularly well-defined but not spectacular either. It is painless and has been there for several years. It has'nt changed that much in appearance during this time and since I've stopped chewing it has become smoother and not as rough as before. I also have a jagged tooth that hangs down and touches this same area so perhaps this is partly the cause. Leukoplakia often dissapears once the irritant has been removed from what I understand. Incidentally, this leukoplakia is just behind a molar that has a really bad cavity in it. Hmmm...can a person have a tooth infection simmering below the surface but not be aware of the infection (ie; no pus, drainage, bad taste in mouth, pain, etc)?.

2) Upper-right-inside cheek area just behind my upper-right wisdom tooth. There was a small, white plaque there which began a few months ago as a canker sore-type lesion. I never looked at it but it was sore for about a week and felt like your typical canker sore. Anyway, this has reduced to a small white patch over time and it continues to shrink by the day and is not at all sore. Do canker/H.Simplex sores start out and end this way or leave a white scar that can take some time to heal over? (I've often wondered about this).

3) Lower-right region of jaw where I had a first and second molar extracted several years ago. There was some leukoplakia-like areas there which completely dissapeared 3-4 days once I quit chewing. Based on the excellent description you provided with respect to the location of the lymph nodes in the head/neck region, I'm going to tell you that my tonsillar nodes are not swollen. I'm also going to say that my left submandibular node has been moderately swollen for perhaps a decade or more but is not at all painful. My submental nodes are another story however and based on your description, the ones I believe are swollen and causing some soreness. I'm not sure if swelling of the submental nodes is diagnostic of any specific disorder but I'm hoping this might narrow the list down at least little bit.

You mentioned that cervical nodal enlargement is most commonly seen with the onset of oral cancer. I'm not sure (exactly) where the cervical nodes are or how big they would have to be, etc. Could you elaborate on this a little bit please?. Also, you mention that if left untreated, it can migrate to the front of the neck (how far down?). Finally, can oral cancers present as a non-visible mass within the tissue of the jaw or do they almost always start out as something fairly obvious?. In other words, can (or do) oral cancers/sores "hide" or lurk below the surface and spread undetected?. Also, is node size fairly significant or level of soreness significant?.

Just a quick note: Right now my sinuses are prett stopped up, there is some drainage with small flecks of blood here and there, my jaw-hinges (and my face) feel sort of "tight" like a mask and my head feels sort of spacey with mild soreness around my head/face/neck area. Sorry for so many questions and no, you definately did'nt bore me. I am actually in awe of your knowledge to tell you the truth as well as very greatful that you would take the time to reply to my concerns in such detail.

- Thank you and have a GREAT Christmas!!:-)

- Joe

 
Old 12-21-2003, 10:03 PM   #5
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Join Date: Oct 2003
Posts: 118
fudd HB User
Re: Nodes under jaw sore and swollen - (scared!)

First off, Joe, you are very welcome for the information. As I think I told you earlier, I try to let people who have a lot of these diseases/disorders talk to each other, as that is really the intent of this forum. However, when I can see that someone is not getting responses or has a very rare/unique problem or question, I'm more than happy to help out as much as I can.

On to your follow-up questions:

As I mentioned earlier, all lymph nodes eventually reach the cervical lymph nodes in some way or another. These are the major nodes in the upper third of the body and are sometimes referred to as the deep cervical lymph chain. This is because there is literally a chain of nodes that run along the side of your neck from a few cm above the level of the Adam's apple to a few centimeters above the collar bone. Incidentally, they are called cervical due to their location relative to the spine; when you refer to spinal segments, cervical segments are those found in the neck - these nodes are in the neck, so they call them cervical as well.

Anyway, everything above collarbone ultimately drains into the cervical nodes. The chain is located inferior enough in the body that even parts of the thorax can drain upwards into them (so a lot of times, lung and breast cancers can show up here). In your case, however, you want to consider the flow path into the other nodes in the head. Now I have to admit - I had to do some homework here, because I don't know many people who walk around with these patterns memorized (I suppose some astute ENTs do - God bless them):

The tongue drains into three different paths: The tip drains into submental nodes and then to cervical, the first 2/3 drains into the submandibular nodes and then to cervical, and the back 2/3 straight into deep cervical.

The tonsils drain into tonsillar and then into cervical and also straight into cervical.

As for the face, the central lower lip/chin drains into submental and then to cervical. The forehead and the front of your face (nose, cheeks, etc) drains into submandibular and then cervical. The sides of your face (temples, around your ears, etc) are kind of funny in that they first drain into your parotid gland (located just in front of your ear lobe), which drains into submandibular, which then drains into cervical.

All of the inner structures (larynx, pharynx, etc) drain straight into the cervical nodes.

Now - here is where my ability to help you is limited, because if you are telling me that your submental nodes are most enlarged and painful, I (as would most logical people) would assume that this would mean that it would involve the tip of your tongue or your central lower lip/chin, as per the above information. However, that just doesn't feel right to me. These pathways are only guidlines and not necessarily hard rules - I would imagine that if you have an infection anywhere above the neck, the infection could reside in any of the lymph nodes listed above. All that the above information tells us is which anatomical structure drains into what nodes, NOT what structures might be infected or transmit infection. Lymph drainage paths are very useful when you are tracing a tumor through the body (i.e. it justifies a liver tumor showing up in the cervical nodes, lung cancer showing up in nodes near the groin, etc), but I just don't know how it works for short distances like this. This is the kind of thing that keeps an ENT employed :>

You had asked how big the cervical nodes might be in the case of infection, cancer, etc. Tough to say, because it's like drug interactions - everyone's body is really different and reacts differently to different bugs/drugs/tumors. What IS safe to say is that if you have nodes greater than the size of a large marble (i.e. quite visibly raised from the skin), you probably have a pretty good infection. If you have multiple nodes like this, you definitely have an infection. And if you have multiple nodes in multiple locations, that can be a sign that you have something more serious (this is pretty common with HIV patients). However, if you have a few that are pretty small, the size of a pea, as you said, I wouldn't worry much. If they start getting larger or if they start getting very warm to the touch and red, you should get to your doctor right away - this would be a sign that the source of the enlargement is snowballing.

Finally, oral cancers: In contrast to most other types of tumors in the body, the appearance can be REALLY variable. It can range from ulcers to lumps to changes in color. While it is far more common for an oral cancer to present as an ulcer or otherwise unpleasant looking entity in the mouth, it is possible for it to arise as nothing more than a large bump. This bump would likely be both visible and palpable (when you touch it, you can tell that it's not supposed to be there). Again, though- this is rare, and most docs will expect to see something that looks like a tumor if you tell them you have oral cancer. If a cancer were located underneath the surface, it would not be an oral cancer (almost by definition - oral cancers can also be called "cancers of the oral mucosa", mucosa being the soft, pink tissue of the mouth/gums - mucosa is always exposed). That is to say that it would probably be a cancer of the bone, or of the thyroid, or of one the salivary glands, etc - once you get past the oral mucosa, you hit muscle (which has it's own type of tumor), bone, vessels, etc. But these all have different risk factors, epidemiology, pathological effects, etc. If that were the case, only some of what we've been discussing would be pertinent and we'd have a whole different set of factors to consider. Cancers can start out in the mouth and spread underneath or to the jaw, but if they start elsewhere, they are something else. Rule of thumb: tumors are defined by where they begin.

Finally, I appreciate your kind words about my knowledge - but please know that there are people on this forum (I won't name names) who could run medical circles around me. We have some very experienced, very intelligent people around here. The beauty of this forum is that no matter what your knowledge base is, there is almost ALWAYS somebody to learn something from.

If you have any more questions, please feel free to ask - I'm glad to answer anything else that I may have missed.

Last edited by fudd; 12-22-2003 at 12:26 AM.

 
Old 12-21-2003, 10:24 PM   #6
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Join Date: Sep 2003
Posts: 194
tryingtofeelgood HB User
Re: Nodes under jaw sore and swollen - (scared!)

Quote:
Originally Posted by Hi_its_Joe
Wow Fudd, I don't even know where to begin except to extend my heartfelt appreciation to you for the extent to which you addressed my issues and concerns. Your reply was was articulate, thorough, well-balanced, intelligent, professional and very helpful!. One thing is certain; you are definately very knowledgable and are to be commended for your willingness to selflessly assist others on this board (including myself) the way you have. Now perhaps that sounds a bit mushy but I'm just VERY greatful and it's the truth. You certainly know considerably more that I do!:-).

Anyway, I wanted to mention that since I've started on the smoking cessation adjunct (ie; the gum) and ceased chewing over the past 4 days, I have begun to notice a gradual (but significant) decrease in the size of the leukoplakia (pl?). I'm going to guess that this is a good sign Also, at this time I do not have any of the inflamed red patches characteristic of the more aggressive erythroplakia that you mentioned (also a good sign I'm hoping/guessing). The location of my leukoplakia and thier status are as follows...

1) Lower-left region of jaw directly over the spot where I had a wisdom tooth extracted over 20 years ago. Over this area is a small, slightly wrinkled opaque-white patch approximately the diameter of a baby sweet pee with a border that is not particularly well-defined but not spectacular either. It is painless and has been there for several years. It has'nt changed that much in appearance during this time and since I've stopped chewing it has become smoother and not as rough as before. I also have a jagged tooth that hangs down and touches this same area so perhaps this is partly the cause. Leukoplakia often dissapears once the irritant has been removed from what I understand. Incidentally, this leukoplakia is just behind a molar that has a really bad cavity in it. Hmmm...can a person have a tooth infection simmering below the surface but not be aware of the infection (ie; no pus, drainage, bad taste in mouth, pain, etc)?.

2) Upper-right-inside cheek area just behind my upper-right wisdom tooth. There was a small, white plaque there which began a few months ago as a canker sore-type lesion. I never looked at it but it was sore for about a week and felt like your typical canker sore. Anyway, this has reduced to a small white patch over time and it continues to shrink by the day and is not at all sore. Do canker/H.Simplex sores start out and end this way or leave a white scar that can take some time to heal over? (I've often wondered about this).

3) Lower-right region of jaw where I had a first and second molar extracted several years ago. There was some leukoplakia-like areas there which completely dissapeared 3-4 days once I quit chewing. Based on the excellent description you provided with respect to the location of the lymph nodes in the head/neck region, I'm going to tell you that my tonsillar nodes are not swollen. I'm also going to say that my left submandibular node has been moderately swollen for perhaps a decade or more but is not at all painful. My submental nodes are another story however and based on your description, the ones I believe are swollen and causing some soreness. I'm not sure if swelling of the submental nodes is diagnostic of any specific disorder but I'm hoping this might narrow the list down at least little bit.

You mentioned that cervical nodal enlargement is most commonly seen with the onset of oral cancer. I'm not sure (exactly) where the cervical nodes are or how big they would have to be, etc. Could you elaborate on this a little bit please?. Also, you mention that if left untreated, it can migrate to the front of the neck (how far down?). Finally, can oral cancers present as a non-visible mass within the tissue of the jaw or do they almost always start out as something fairly obvious?. In other words, can (or do) oral cancers/sores "hide" or lurk below the surface and spread undetected?. Also, is node size fairly significant or level of soreness significant?.

Just a quick note: Right now my sinuses are prett stopped up, there is some drainage with small flecks of blood here and there, my jaw-hinges (and my face) feel sort of "tight" like a mask and my head feels sort of spacey with mild soreness around my head/face/neck area. Sorry for so many questions and no, you definately did'nt bore me. I am actually in awe of your knowledge to tell you the truth as well as very greatful that you would take the time to reply to my concerns in such detail.

- Thank you and have a GREAT Christmas!!:-)

- Joe
To add to Fudd's posting: Get the lymph nodes checked by an ENT, because if they are enlarged that is an important symptom. the lymph nodes are an important part of your immune system and they filter out foreign bodies, they enlarge because the lymphoid tissue is stimulated to produce more cells. It should never be ignored. It could most definitely be dental related - an infection that is in your jaw/sinus area. You may get a test called a 3 phase bone scan which will determine if this is true. There are also tests to determine if you have an infection - try SED rate and CBC (white blood count) and also add a C-Reactive Protein test in case the infection is there and has been for a while. Try an University Hospital/Medical Center - for more advanced testing. Please update us on your progress. I hope you get to the bottom of this soon

Happy and Healthy Holidays!

 
Old 12-21-2003, 10:59 PM   #7
Hi_its_Joe
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Re: Nodes under jaw sore and swollen - (scared!)

Hi again Fudd

Well, all I can say (while trying to contain my gratitude and not get too "cheesy") is...WOW. Your right. There are indeed a lot of wonderful, caring and intelligent people in these forums. In fact, I have never quite seen a forum like this in the short 7 years I've been sitting in front of this thing nor the caring and considerate people who frequent it. It is certainly a unique place!.

Accolades aside and while not pushing my luck too far, I actually do have a few (brief) questions if you don't mind. Once again, thank you for sharing your knowledge with me as I'm sure you can appreciate how indespensible this is when a person becomes frightened about thier health and is searching for answers. Anyway, here they are...

1) Would you necessarilly expect a person in the early or mid stages of oral cancer to present with a fever?

2) Is nicotine gum (at least potentially) carcinogenic? - (I've read that nicotine can produce tumor causing compounds called nitrosamines, however, this is usually tied to the curing process of tobacco). Nicotine by itself, although highly addictive, is usually thought of as harmless.

3) When you use the term ulcer, I am picturing a small, reddish and irritated herpes-like sore (or a canker sore) - a shallow, sulcus or pit in the mouth, etc. I'm not sure if this is what you mean by "ulcer" or if you mean some of those gruesome pictures I've seen on the internet where some poor guy has rather large and ugly hole eaten through the side of his cheek with pus or blackish fluid leaking around it. Everyone gets sores in thier mouth from time to time but I'm not exactly sure where a small, innocuous sore ends and a dangerous (or at least suspicious) malignancy begins.

4) Is the fact that since I've stopped chewing the white patches have begun to either dissapear or reduce a good sign and what do you make of it?

Anyway, these were the last few questions I had. I won't keep you too much longer although I'll admit that it is always tempting to try to get that extra question in at the last minute. Once again, I really appreciate your help!.

- Joe

 
Old 12-22-2003, 02:03 AM   #8
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fudd HB User
Re: Nodes under jaw sore and swollen - (scared!)

Hi Joe,

Not a problem at all, I can try to answer as many questions as you have.

1) No, I would not necessarily expect a person with early oral cancer to present with fever. In fact, a person with early oral cancer usually doesn't even know there is a problem. Most people don't thoroughly inspect their own mouths, and even though it is part of a complete physical examination, physicians rarely do a complete physical (it's unfortunately just not reasonable for most practices to take an hour per patient in this age of managed care). Most office visits involve some key physical exam components and a few focused inspections based on epidemiology and risk factors. For this reason, neither the patient nor the physician are usually aware of the cancer before it has become symptomatic (pain, difficulty speaking, etc) - at this point, it may have already begun to metastasize. In fact, it is usually the dentist that picks this sort of thing up, for obvious reasons. Back to fever: Fever is pretty much limited to anything involving the immune system, usually due to infection, but sometimes involving allergic and anaphylactic reactions. This is because it is the cells of the immune system that actually secrete chemicals called interleukins and prostaglandins on demand - these chemicals in turn affect the hypothalamus in the brain to change the temperature set point of the body. This is getting beyond the scope of the question, but you get where I'm going with it.

2) Yes, this is the common misconception - nicotine is NOT a carcinogen. People make too many funny jumps in logic when it comes to cigarettes: Cigarettes contain nicotine; cigarettes cause cancer; therefore, nicotine causes cancer? Not exactly. You are quite correct that it is nitrosamines that are the cancer causing agents in tobacco (among others). Additionally, there are many other carcinogens that don't get nearly as much press as they should. If I remember the chemistry right, cigarettes actually contain molecules called conjugated dienes that combine to form benzene at high temperatures - benzene is the carcinogen here. It is more common that carcinogens are formed rather than found in the tobacco itself. Anyway, the nicotine gum is quite safe. It will raise your blood pressure a bit (nicotine acts on receptors that help to regulate blood pressure - net result is constricted vessels), but other than that there should be no problem. For your reading pleasure, here is the US Dept of Health 2002 report on known and suspected carcinogens (side note that I found surprising - phenytoin, the antiepileptic drug commonly known as Dilantin, made the list!): [url]http://ehp.niehs.nih.gov/roc/toc10.html[/url]

3. Actually, either one of your descriptions could be an ulcer. Ulcer is actually a pretty generic term. Tumors are generally consider to have one of three qualities: exophytic (growing outward from the surface); flat (growing neither outward nor inward from the surface - this may be perceived as a change in color or texture); and ulcerative (growing inward from the surface and leaving a depression of any sort). These can look like what you consider to be a canker sore (a shallow, inward, discolored growth that has an even distribution and/or color) or the real nasty looking kinds (deeper, not as neatly defined or organized, not evenly encircled or colored, etc). Only when they get to the point where they have really started to take off will they really start looking bad (and large - they get wider/deeper as time passes). When they are just starting out, it will look less intimidating and more like a sore.

4) In terms of what I make of the regression, I don't have a whole lot of experience with prognosis for this sort of lesion - this is definitely a question for the ENT. I wish I had the knowledge/experience to answer this question, but I don't want to steer you wrong on this. I've read at some point that at least 1/3 of leukoplakias can completely regress if the inciting agent (i.e. chewing tobacco) is stopped. I also know that the biopsy is always the best determination of the diagnosis/prognosis of a leukoplakia. If there are no dysplastic (i.e. precancerous) cells found at biopsy, then the odds are highly in your favor for not developing an oral cancer. If there are in fact dysplastic cells discovered on biopsy, you will need to work with your ENT and keep an eye on the lesions (swab/biopsy every few months) so that you can act early and quickly in the event that some of the dysplastic cells become malignant.

Again, please feel free to ask any questions that might come to you. If you see your ENT soon, please keep this thread updated with any new information. Take care!

- fudd

 
Old 12-22-2003, 09:30 AM   #9
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teapots25 HB User
Re: Nodes under jaw sore and swollen - (scared!)

Hi,
I had this problem about 2 years ago, I was also very worried but the doctor had told me that it was from having a sinus infection and when it drips down your throat you have a tendency to swallow alot which inflames the lymph nodes udder your jaw which are your salavary glands.

 
Old 12-22-2003, 09:55 AM   #10
Hi_its_Joe
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Re: Nodes under jaw sore and swollen - (scared!)

Well, you people have been really incredible. Anyway, I am hearing and reading a lot lately that many of my symptoms can (and often are) caused by sinus-related infections, allergies, etc.

On this subject, I am quite familiar having come from a family who's middle name is A-L-L-E-R-G-Y. This would be on my mother's side and every time I call her on the phone she is telling me about having a headache, being achey, sinuses plugged solid, the "sniffles", pressure, feeling run-down, etc.

I myself am a horrible sufferer and have been diagnosed with acute sinusitis and allergic rhinitis. I also have a deviated septum on the left side from where I was play-boxing with a freind of mine (guess who won?..lol). Anyway, the friend accidentally popped me right in the nose and broke it. I never had it fixed. Heck, I was young and healthy at the time and I could "take it". Of course, that was 25 years ago and now that side gets very clogged up and causes me a lot of problems. I have always had a slightly reddened throat, fluid in my ears from time to time and other symptoms (fatigue, dizzy spells, red/green specks of blood when I blow my nose sometimes, etc) for as long as I can remember. I gues it does'nt help matters that I am an animal lover and have lots of birds, goats, etc (my mother is very allergic to hay and goose down and I DO have a pet goose!).

I actually have an appointment to see an ENT early next month to rule out any serious problems and I even made an appointment to see a second ENT just in case the first one turns out to be one of those types who tells you to "go home and take an aspirin" after making you wait all day and only seeing you for 2 minutes. I'm also going to my regular clinic later today and hope to get a CBC w/Diff to rule out any infectious processes going on or other "red flags" along with an MRI of my head and neck (hopefully with contrast material) to rule out any suspicious subQ/intraM tumors or other nasties.

I'll keep you all posted on how everything comes out when I get back and thank's again for all the GREAT help!.

- Happy Holidays!!

Last edited by Hi_its_Joe; 12-22-2003 at 09:59 AM.

 
Old 12-22-2003, 04:04 PM   #11
Hi_its_Joe
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Re: Nodes under jaw sore and swollen - (scared!)

I just got home from the clinic a little while ago. Before I left, I had this perfect little idea of everything I wanted once I got down there (ie; MRI, CBC/Diff, antibiotic, etc). After I arrived, I had to sit a few hours (which I did'nt mind) but finally the doctor walked in. I explained the whole deal to him and he began his examination.

He told me that I did'nt have swollen lymph nodes which is exactly what the ER doctor told me last night. Gawsh, I think I know when my own lymph nodes are swollen and sore but then again, these docs don't live in my body and maybe your nodes have to be a certain size before they get concerned. He also looked up my nose, saw my deviated septum and remarked "yeah, it looks kind of boggy in there". Boggy??...lol. Anyway, the doc told me I did'nt need a CBC because he was going to give me a course of Z-Pak (Azithromycin) anyway and an MRI was'nt indicated. His final diagnosis was a "viral URI" (Upper Respiratory Infection). Since we are in the middle of flu season, I'll bet he gives most of his patients this "canned" diagnosis but at least I got the antibiotic I wanted (Z-Pak is a powerful, broad spectrum AB which I tolerate very well and you only need a few doses to wack the little nasties out of your system.

Of course, none of this means that I don't have some huge tumor growing through my left eye socket..blah...blah...but at least maybe I can get a little relief. Oh, I also got Allegra which my mom takes and which is supposed to be some GOOD stuff:-)

- Me

 
Old 12-22-2003, 09:25 PM   #12
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bassie HB User
Re: Nodes under jaw sore and swollen - (scared!)

Quote:
Originally Posted by Hi_its_Joe
His final diagnosis was a "viral URI" (Upper Respiratory Infection). Since we are in the middle of flu season, I'll bet he gives most of his patients this "canned" diagnosis but at least I got the antibiotic I wanted (Z-Pak is a powerful, broad spectrum AB which I tolerate very well and you only need a few doses to wack the little nasties out of your system.

- Me
Hey Joe, don't be too hard on the man
He probably is right if it is flu season. Bit boring for a doctor too to be handing out the same diagnosis all the time.
At least you can eliminate a couple of things before you see the ENT. (Sinus and UTI).
Now "take an Asprin and a good strong cup of tea' and enjoy the festive season without panic. That doctor would have noted *something* to send you packing post haste for further checks I am sure.
We are all waiting for your ENT and the report that all is OK.
Hugs
~bassie

 
Old 12-23-2003, 10:36 AM   #13
Hi_its_Joe
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Re: Nodes under jaw sore and swollen - (scared!)

Ok, thank's a bunch Bassie and all the rest of you. I'll be going to see the ENT in about 10 days and another one about a week after that. I'll keep you all posted and thank's so much for your support and help!:-).

Well, I'm off to bake no less than 8 different kinds of Christmas cookies and stir my homeade spagetti sauce...tis the season...fa...la...la...

- Happy Holidays

 
Old 12-23-2003, 06:32 PM   #14
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Timber HB UserTimber HB User
Re: Nodes under jaw sore and swollen - (scared!)

Lymph nodes that hurt are a sign of infection. Cancerous lymph nodes don't hurt.

 
Old 12-24-2003, 10:51 AM   #15
Hi_its_Joe
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Re: Nodes under jaw sore and swollen - (scared!)

Quote:
Originally Posted by Timber
Lymph nodes that hurt are a sign of infection. Cancerous lymph nodes don't hurt.
Both hinges of my jaw feel puffy, sore and a bit strange. The nodal swelling under my jaw feels like maybe it's gone down just a bit but nothing to get excited over at the moment. In addition to these things, I also have a mild, metallic taste coming from this same area (way back at the hinges of my jaw on each side). I have heard that with oral cancer, there can be "changes in taste perception". This is what scares the heck out of me. I was on Celexa for a week which can cause the metallic taste but I discontinued it 3-4 days ago so it should be gone by now...yes?. Also, I've been taking "Z-Pak" (Azythromycin) for 3 days in case I have an infection (hopefully it will do some good). At the beginning of all this I had developed a bad habit of scissoring my jaw back and forth to "test" for jaw impairment caused by oral cancer. I've stopped this habit but hopefully I hav'nt done any long-term damage. I do not feel so good and Christmas is tommorow. This is really starting to get me down )-:

- Me

 
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