Suggest Treatment For Swollen Lymph Nodes Under Jaw

Posted on Fri, 28 Nov 2014

Question: Hi,

I have two swollen lymph nodes under my jaw. One is rubbery and moves, approximately 2.5cm and the other is harder and slightly larger. I have no other symptoms hence why I was not originally worried about these. I have seen a specialist who put a camera down my throat and although I have had my tonsils removed around 20years ago believed that I have a lot of tissue at the back of my throat. I don't suffer from a sore throat. Don't smoke or drink. I've been referred for an mri but have a month to wait. Since then I have also noticed a small lump on the top of my breast, that feels like a lymph node. I'm really concerned that everything seems to point to lymphoma. Is there anything else it could be? I've had the swollen lymph nodes for about 1year and have had my ears and throat checked for infections and they were fine. I also don't understand what an mri will show as surely I'll only be referred for a biopsy but I'm conscious of the long waiting times.

Answered by Dr. Dr. Naveen Kumar Nanjasetty (57 minutes later)

Brief Answer:
I doubt lymphoma...

Detailed Answer:
Hi

Thanks for posting the query and an elaborate history. I will try my best to help you with this.

Lymphomas are not diagnosed purely based on the presence of a lymph node. History, blood investigations, fine need aspiration cytology (FNAC) of the lymph node, etc., are required before labeling as lymphoma.

1. History:
Fever and chills, night sweats
Unexplained weight loss, loss of appetite

2. On physical examination:
Painless swelling of lymph nodes noticed in the neck, armpits or groin
Enlarged spleen

3. Blood investigations: A complete blood count to check for any variation in the white blood count.

4. FNAC of the lymph node, to rule out lymphoma

5. CT Scan or PET scan to look for the malignant nodes. I doubt the benefit of MRI.

Hence, pertaining to your case, I doubt you are having lymphoma. Sub-mandibular lymph nodes are noticed when there is infection in the oral cavity, chin and the floor of the tongue. Lymph nodes in the Jugulo-digastric region swell up, if the infection is noticed in the tonsils or posterior pharyngeal wall.

My suggestion to you is to take a course of broad spectrum antibiotics. It will reduce the size of the nodes. If the lymph nodes do not reduce in the size even after the antibiotic course and if you still suspect lymphoma, it would be better to get a FNAC done. This will give us a complete picture into your problem.

Hope this answers your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Dr. Naveen Kumar Nanjasetty (3 hours later)

Thanks. That's reassuring to know. I have had blood tears, for full blood count, thyroid function and kidney function I believe. I had a notification that these came back normal. Would this be enough to rule out lymphoma?
Could you explain what excess tissue at the back of my throat could be? I haven't got any tonsils and don't have sore throats etc.
I don't understand why I am being referred for an mri and what they could be looking for with this?

Answered by Dr. Dr. Naveen Kumar Nanjasetty (2 hours later)

Brief Answer:
It partially rules out lymphoma...

Detailed Answer:
Hi

Thanks for writing back

1. It's a good news if the blood counts are normal, it indicates absence of infection or any inflammation. It partially rules out lymphoma.

2. The excess tissue could be hypertrophied lymphoid follicles over the pharyngeal wall. The hypertrophy may be secondary to allergy, acid reflux disease, recurrent throat infection, etc.

3. I'm not sure why your doctor is getting a MRI done.

Hope this clarifies your doubts. I wish you good luck and good health.

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj