Lymphadenopathy in the Submandibular Triangle: Key Concerns and Insights

Lymphadenopathy of the submandibular triangle?

Hello Dr.
Zheng,
I have a few questions to ask you.
I have enlarged lymph nodes in the submandibular triangle on both sides of my jaw.
I have undergone ultrasound and nasal endoscopy, and the nodes are firm, mobile, and slightly oval in shape.
They have been enlarged for almost a month now; they haven't increased in size but feel slightly smaller upon touch.
1.
I recently had another ultrasound.
The previous measurement was about 0.8 cm, and this time it measured about 1 cm.
The doctor said there hasn't been much change and that the appearance of the lymph nodes doesn't seem concerning.
I would like to know if there could be discrepancies in measurements taken at different times (due to angles or precision), or does this indicate that the lymph nodes have indeed increased in size? Can the appearance alone indicate anything?
2.
The lymphadenopathy has persisted for almost a month now.
Although there hasn't been much change, is there a possibility of malignancy? The doctor advised monitoring it.
How long should I observe it before considering it stable?
3.
I noticed in other Q&A sessions that doctors mentioned continuing to observe as long as there is no increase in size or persistent pain.
Currently, I do not have continuous pain, but I occasionally experience mild sharp pains or slight discomfort 1-2 times a day, which usually resolves after a while.
Should this be considered abnormal? Is it classified as persistent pain?
4.
I have some swelling on the inside of my left cheek, but it is not painful.
Doctors have examined it and found no abnormalities.
Since the location is similar to that of the lymph node enlargement, could this be related?
I apologize for my excessive worry, but I hope you can help clarify my concerns.
Thank you very much for taking the time to respond amidst your busy schedule.
I sincerely appreciate it.

Fanrao Yilü de Ren, 30~39 year old female. Ask Date: 2020/06/23

Dr. Zheng Jueyi reply Otolaryngology

Hello,
1.
There may be slight discrepancies in ultrasound measurements.
If the physician indicates no significant changes, it is advisable to monitor the situation.
A follow-up appointment can be scheduled in 3 to 6 months for further evaluation.

2.
It is recommended to return for a follow-up examination in 3 to 6 months.

3.
Occasional pain may not be significantly related to the lymph nodes.

4.
If no abnormalities have been found upon examination, monitoring is acceptable.

Wishing you peace and good health.

Sincerely,
Dr.
Cheng Jue-Yi
Director, Department of Otolaryngology
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2020/06/23

More Info

Lymphadenopathy, or swollen lymph nodes, can be a source of concern for many individuals, especially when accompanied by other symptoms or when it persists over time. In your case, you have noted the presence of enlarged lymph nodes in the submandibular triangle for nearly a month, with some fluctuation in size. Let’s address your questions and provide some insights into the potential implications of your condition.

1. Ultrasound Variability: It is indeed possible for ultrasound measurements to vary slightly due to factors such as the angle of the probe, the operator's technique, and the inherent variability in the tissue being examined. A change from 0.8 cm to 1.0 cm may not be clinically significant, especially if the lymph node's characteristics remain consistent (e.g., shape, texture). Lymph nodes can also change in size due to various factors, including inflammation or infection, so a slight increase in size does not necessarily indicate a malignancy. The appearance of the lymph node (e.g., oval shape, mobility) is also important; nodes that are soft, mobile, and have a regular shape are generally less concerning than those that are hard, fixed, or irregular.

2. Duration of Observation: The recommendation to observe lymphadenopathy is common, especially when there are no alarming features (e.g., significant growth, persistent pain, systemic symptoms like fever or weight loss). Generally, if a lymph node remains stable in size and does not exhibit concerning features, it can be monitored for a period of 4 to 6 weeks. If there is no change after this period, it is often deemed stable. However, if you have any new symptoms or if the node begins to grow, further evaluation may be warranted.

3. Pain and Discomfort: Occasional mild discomfort or transient pain in the area of the lymph node is not uncommon and does not necessarily indicate a serious issue. Continuous pain or significant discomfort would be more concerning. The fact that your discomfort is intermittent and resolves quickly is generally reassuring. However, it is essential to remain vigilant and report any changes to your healthcare provider.

4. Facial Swelling: The swelling you describe on the inside of your left cheek could be related to several factors, including dental issues, salivary gland problems, or even the lymphadenopathy itself. Since the location is near the lymph nodes, it is possible that there is a connection, but it is also possible that it is an independent issue. If your healthcare provider has evaluated this and found no abnormalities, it may be a benign condition. However, if the swelling persists or changes, further investigation may be necessary.

In summary, while lymphadenopathy can be concerning, many cases are benign and resolve on their own. The key factors to monitor include the size of the lymph nodes, any changes in symptoms, and the presence of systemic signs of illness. If you continue to have concerns or if there are any changes in your condition, it is advisable to follow up with your healthcare provider for further evaluation. Regular monitoring and open communication with your doctor are essential in managing your health effectively.

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