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Noticed swelling in cheek. Started pain in shoulder and ankle bone. Any advise?

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ENT Specialist
Practicing since : 1991
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The query is for my boyfriend who noticed today that he had a swelling along the bottom of his left cheek towards the back to the ear. It continues to swell while eating. It became quite painful so we went to the ER. The ENT said it might be a stone in his salivary glands and to go home and keep it iced and if it hasn't improved in 2 to 3 days, to return. The swelling/lump is movable under the skin and is the size of quarter. XXXXXX has a history of skin cancer and recently started to get pain in his shoulder and ankle bones. I read on a website that RA can present with swelling in general regions of the lymph glands. Please advise.

Thank you
Posted Mon, 15 Oct 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for your query.

1. If the swelling increases while eating, it is most likely to be a salivary gland swelling. Clindamycin is the preferred antibiotic as it achieves a good concentration in saliva.

2. A sonography (Ultrasound) of the neck will help differentiate this swelling from a lymph node. There are around 300 lymph nodes in the head and neck region. An FNAC (Fine Needle Aspiration Cytology) will settle the issue whether this is a lymph node, salivary gland tissue, a metastasis or something else.

3. Rheumatoid Arthritis may present with swollen lymph nodes or even salivary gland dysfunction, A battery of tests including RA Factor, ESR, C-Reactive Protein, Anti Nuclear Antibodies, Joint X-rays and so on.

4. A bone scan and a bone densitometry may be required to investigate the shoulder and ankle pain.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

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