Nodes under jaw sore and swollen - (scared!)

[tryingtofeelgood]

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!

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

[fudd]

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

[teapots25]

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.

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!!