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What Causes Loss Of Voice With Normal Endoscopy And Feeling Something Behind Jaw Line?

Posted on Mon, 24 Nov 2014

Question: I went to a GP because of loss voice and I felt a tiny difference between my left and right jawline (under ear in the small of the jaw line). The GP couldn't find it and I had to place her finger on it. Still, she couldn't tell but recommended to visit the ENT. I have had poor dental and had to replace my upper left crown due to decay. I went to the ENT. Had an endoscopy done and full neck and head evaluation. I checked out fine except for slight acid reflux and some sinus allergies. I went to dentist and he also felt around the concerned area and couldnt find anything. An xray was taken of the tooth area and he removed the #15 crown, cleared decay and placed a temp crown on which was 3 weeks ago. I feel something still occupies the area behind my left jaw line about a 1/2 inch under my ear lobe. Eventhough I do not have any additional symptoms, I am fearful of something serious. I do have fat in my face which makes it harder to tell. I have been constantly prodding at it and maybe thats why it feels a bit larger. I dont know. Can you tell me what this possibly is? I definitely feel something.

Answered by Dr. Naveen Kumar Nanjasetty (35 minutes later)

Brief Answer:
Lymph node or the mastoid tip...

Detailed Answer:
Hi

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

The commonest structures which we come across the area described by you are:
1. Jugulodigastric lymph node
2. Tail of parotid gland
3. Tip of the mastoid bone
4. Elongated styloid process
5. Thickened or calcified stylo-hyoid ligament, etc.

After going through the description given by you, I do feel, you could be palpating either a lymph node or the mastoid tip. I doubt anything serious, as you have already got an endoscopic examination done.

If you are still concerned about your finding, please get an ultrasound of the neck done with or without a CT Scan. These investigations will pick up any abnormal structures in Jugulodigastric region.

Hope I have answered your query; I'll be available for the follow up queries.

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

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

Follow up: Dr. Naveen Kumar Nanjasetty (5 hours later)

I wanted to mention a couple other details.

I watched my uncle pass away in hospice in April 2014, from a terrible neck cancer which protruded from his neck and I have been very freaky about anything with my body, especially the same area and side of neck. He smoked his whole life including work hazards. Nothing that I know is hereditary. My sister thinks I may have a light case of post traumatic stress disorder because of his death?

Also, I do not smoke, No drugs, but I like my light beer.

My father felt the area as well, noticing the cylindrical feeling object that rolls around when pushed. He said that it may be my fatty cheeks that has possibly altered the touch of whatever it is. Sometimes i think I feel a mass under that rolling little object, but I don't know if it is just inflamed tissues from me prodding at it.

I have read also online that no other symptoms occur in some cancer cases that reported a mass or lump. This is the result of searching the neck area with most posts referring to cancer! Frustrating...

Thanks again!

Answered by Dr. Naveen Kumar Nanjasetty (6 hours later)

Brief Answer:
Cylindrical structure felt is sternocleidomastoid

Detailed Answer:
Hi

Thanks for writing back

I do understand your concern, but, it is not necessary that any swelling noticed in the neck should be a precursor of malignancy.

After going through your history thoroughly, I don't see any signs or symptoms in you which can lead to cancer. Oral or laryngeal cancers do not run in families. In exceptional cases, thyroid malignancies can be seen in multiple individuals in a family.

Also, there should be predisposing factors such as long history of smoking, alcohol, tobacco chewing, etc. Your uncle had those habits, hence he succumbed to it. Just by drinking beer once in a while, an individual cannot get malignancies.

If you are still concerned, get a complete blood check up done, along with an ultrasound of the neck with or without CT Scan. This will help to clarify all your doubts.

Finally, the cylindrical structure felt by your father is the sternocleidomastoid muscle. My humble suggestion to you is, to stop worrying and get yourself completely examined.

Hope I have cleared your doubts. I wish you good health and good luck.

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

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

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

Thanks for your time involved with answering my query. Only to clarify, isnt the sternocleidomastoid rather large? This object is very thin and long in that area of initial concern. reminds me of an artery... Anyways, you have substantially relieved my concern and I will not be seeking medical attention unless there is a valid reason!

Thanks!

Answered by Dr. Naveen Kumar Nanjasetty (27 minutes later)

Brief Answer:
No major vessels are palpable in that area...

Detailed Answer:
Hi

Welcome back

You are right Sternocleidomastoid is rather a large muscle in the middle part, but, at its attachment it is a thin bundle.

Around the area described by you there are no major blood vessels in the superficial part which is palpable. The internal carotid artery lies deeper to the sternocleidomastoid and is not palpable in the Jugulodigastric triangle.

Hope I have cleared your doubts.

Good luck

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. Ashwin Bhandari