Disease analysis:
There are papules under the chin and neck, the most common are lymphadenitis and submandibular adenitis, followed by tumors and metastatic cancers. Lymphatic circulation in the face and neck is extremely rich, consisting of most reticular lymphatic vessels, with groups of lymph nodes (Figure 17), which collect lymph from various areas of the mouth and face.
Suggestion:
The role of lymph nodes can not only filter microorganisms, particles (such as dust, foreign bodies) and cells (tumor cells) that enter lymph nodes, but also destroy toxins, which is one of the important barriers for the body's defense. Therefore, many diseases are often accompanied by lymphadenitis or swelling complications.
(1) lymphadenitis. Maxillofacial lymphadenitis mostly comes from odontogenic inflammation, such as periapical periodontitis and periodontal disease caused by dental caries; Chronic tonsillitis can also be accompanied by submandibular lymphadenitis. If not treated thoroughly, acute lymphadenitis can be transformed into chronic lymphadenitis.
At the beginning, the lymph nodes are small, hard and tough, sometimes slightly tender, oblate, with clear boundaries and mobility. If inflammation recurs, it usually adheres.
Lymph nodes are generally the size of soybeans or broad beans, and can be large or small when inflamed. This can last for a long time, but the body's resistance drops, and it can have repeated acute attacks, showing acute lymphadenitis. Chronic lymphadenitis, such as fibroproliferative changes in lymph nodes, cannot completely disappear. Chronic lymphadenitis generally has no obvious systemic symptoms.
(2) Lymph node tuberculosis. Tuberculous lymphadenitis can initially find single, multiple or string lymph nodes under the mandible or one side of the neck, which gradually swell, harden, have no pain or tenderness, and can move without adhering to the surrounding tissues. When it continues to develop, the lymph nodes adhere to the surrounding areas, and all the lymph nodes fuse with each other to form a fixed nodular mass, sometimes the size of dates or eggs.
If the lesion stops developing, the lump will harden. If the treatment is improper, the systemic resistance will decrease, and the lymph nodes will be caseous necrosis and liquefaction, forming cold abscess. The skin surface is not red, hot and tender, and there will be a sense of fluctuation. If the abscess collapses or is cut open, it will flow out like bean dregs or thin rice soup. After the abscess ruptures, it will form sinus or fistula, which will not heal for a long time.
(3) submandibular adenitis. It has a long history, ranging from a few months to several years. At the initial stage of the disease, acute inflammation can occur in the submandibular region of the affected side after eating. There are unpleasant secretions in the mouth, which often cause discomfort or slight pain in the submandibular region. The swollen submandibular gland can be felt in the lower edge of the mandible, which is tender and slightly hard. The submandibular gland duct under the tongue of the mouth floor can be palpated with sialolith or the duct is rope-shaped.
(4) Mixed tumor of salivary gland. It is the most common tumor of salivary gland, especially parotid gland, and submandibular gland can also occur. The early manifestations are painless masses around the earlobe or submandibular region, which are spherical, lobulated or irregular, with clear peripheral boundaries, mobility, no adhesion with surrounding tissues, moderate hardness, and nodular when asked. Tumors grow slowly and have nothing to do with eating, and the history can last for years or years.
Life care:
Metastatic tumors of mandible and neck. This situation accounts for about 3/4 of cervical malignant tumors, and the incidence rate is second only to chronic lymphadenitis and thyroid diseases. Most primary tumors occur in the mouth, nasopharynx or head and neck. The metastatic lymph nodes of tumor are swollen and hard. At first, they are usually single and painless, but they can be pushed, and then they increase rapidly. The mass is fixed in a nodular shape, and local or radiation pain may occur when necessary.