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Periodic tender lymph node on left side
lmerch21 posted:
A bit of background - when I was about 16 I experienced a salivary gland infection (I think) where I ran a fever, the left side of my face swelled quite a bit, and I was placed on an antibiotic which resolved the situation. I am now 26 (female), and ever since then on the same left side I have experienced a tenderness (that is quite painful) about 2x a year (but only on the left, never the right). The pain is along my jaw where it curves and radiates a bit into my ear. I assumed that I had a salivary stone that hadn't gone away and has kept getting infected periodically all this time so I finally made the decision to see an ENT and get an opinion. He of course wanted to see a CT scan so I went ahead and did that this week.

I also want to note that this week I rather fortuitously experienced the painful gland syndrome again on the left side so went in again to have him examine me. He said to him everything felt the same as it did on my initial visit, but he didn't doubt that it was painful to me. But it was not swollen in his opinion. He said everything appeared normal, even my ears which I felt a little pain in on the left.

The CT scan revealed that everything is normal - submandibular glands, parotid glands thyroid, oropharynx, nasopharynx, hypopharynx, larynx, and supra and sub -glottic regions (copying this all from my report). There are prominent bilateral level lla lymph nodes, left slightly larger than the right, but these are not enlarged by size criteria and there is no adenopathy (not sure what this means).

So my doctor says that this is just a tender lymph node that recurs and he said it will be difficult to determine why - but it's not serious. He said if it flares again I can opt to have a biopsy taken which might help determine the source of it. He suggested I ask my dentist to take a look at recent x-rays and determine if there is an abscess or something that is draining near the lymph node (I think).

I guess my question is - has anyone ever heard of something like this? Does anyone have any suggestions for me as to different things to look into to determine the cause? Would you recommend I get it biopsied? Would anyone recommend I get the lymph node in question removed? (I don't know how dramatic that surgery is).

I was hoping to be able to be able to finally resolve this issue and now it appears there is no end in sight. Thanks in advance for any advice.
Rod Moser, PA, PhD responded:
The main reason to biopsy a node in this area would be a suspicion of cancer or a lymphoma. Since the CT scan was really normal (prominent nodes are not suspicious), the ENTs exam was normal, then this is all very good news. Whether you need a biopsy or not, is not something that I can blindly decide...I just do not have the necessary information about your case. No one should have surgery unnecessarily, of course.

Lymph nodes react (get larger or become tender) in response to infection and/or inflammation, usually in their immediate anatomical neighborhood. Searching for a reason for the lymph node response is appropriate, but the source could be anywhere in the head or neck. Again, the CT ruled out a lot of the possibilites, so the ENT was thinking "dental" as a source. There is really nothing inappropriate for you to get a dental consult.
lmerch21 replied to Rod Moser, PA, PhD's response:
Thanks very much for the reply and information.

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