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What Do Oval Lump And Twitching Of The Jaws Indicate?

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Posted on Tue, 14 Feb 2017
Question: hi, male 33 ex smoker now e-cigs. firm non tender, possibly oval lump around 1cm, seemingly directly on the part of the masster which visibly expands when clenching jaw.
present between 4-6 months maybe longer with no real sign of growth.
quivering muscle twitching on cheek same side, present for around a week, now only brought on when flaring nostrils.
thanks
doctor
Answered by Dr. Riddhi Shah (1 hour later)
Brief Answer:
May need to consult Otolaryngologist and Neurologist

Detailed Answer:
Hi,thanks for your query, I have gone through your query.

Hi,you might be suffering from following possibilities:

1.) HMS(Hemi-masticatory Spasm) is a rare unilateral movement disorder and characterized by paroxysmal contractions of jaw-closing muscles, such as masseter.

Chewing, talking, and laughing are the most common triggers precipitating the spasm.
Neurological examination is normal, except for the hypertrophy(enlargement) of the involved muscle or atrophy(reduction in size) in some cases associated with localized scleroderma(characterized by inflammation and thickening of the skin from excessive collagen deposition).

The EMG(Electromyography) finding is helpful in the diagnosis and characterized by irregular bursts of motor unit potentials correlating with muscle spasms.

The cause of HMS is not fully known and is considered to be owing to the result of a problem in the motor branch of the trigeminal nerve.

In such a case ,it would be advisable to consult a Neurologist.MRI Brain may be required to know the cause.Medicines like gabapentin,Carbamazepine or Botulin injection may help in Muscle Twitching.

2.) Lymphnode enlargement-There are about 300 lymph nodes in the head and neck region Normally they are not palpable. During an infection or as a response to inflammation, these lymph nodes enlarge. However they rarely regress to their original size and hence remain palpable thereafter.You might be suffering from Lymphnode enlargement over Masseter muscle which may be of infective/inflammatory origin/or Cancerous.

In such a case ,it would be advisable to consult an Otolaryngologist doctor to do ear,nose and throat examination and find out any cause of infection or inflammation or any cancerous growth.

If the node is cancerous,then it would be hard,non-motile,more than 1 cm in size and it keeps on increasing in size.
Looking at your description of swelling,it does not seems to be cancerous.

I would advise you to go for Ultrasonogram (USG) and USG guided FNAC(Fine Needle Aspiration Cytology)-to find out the cause over swelling over your Masseter muscle.

I would also advise you to quit smoking as it may lead to cancer of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach,etc.

I hope my answer will help you, take care.

I would be happy to answer if you have any follow-up questions.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Riddhi Shah (22 minutes later)
thanks. Does the location I described rule out parotid tumor? the lump is not attached to the skin above and appears to have a clearly defined smooth border on palpation.

it feels attached to the muscle below.

twitching under eye on cheek only started around one week ago and was intermittent, now it feels like the muscle spasm is weaker but happens every time I expand/flare my nostrils.

the lump predated the twitching by a long amount of time.

is there a chance that they are unrelated?

if it was a cancerous parotid tumor would it not mestacise to surrounding tissue before the facial nerve?

if a tumor invades the facial nerve would it's interference be constant or could it present as I described?

thanks
doctor
Answered by Dr. Riddhi Shah (16 hours later)
Brief Answer:
USG and FNAC would help to reach the diagnosis.

Detailed Answer:
Hi,Thank you for your reply.

Tumor arising from accessory part of parotid gland might be seen as a swelling over Masseter muscle. Incidence of accesory parotid gland tumor is 70% benign and 30% malignant.Generally it is not attached to the muscle.

If it is a malignant tumor,then the swelling would be hard,irregular margins,infiltrating surrounding tissues,might get attached to masseter muscle,etc.

In your follow-up question,I came to know that you are suffering twitching around eye.
In a parotid gland tumor,Facial nerve(7th cranial nerve) might get affected .
Hemifacial spasm is a condition that affects half of your face. It usually starts with a twitching around one eye.If something presses on the facial nerve somewhere along its course, it can affect how the signals are carried to the face. This may cause muscles to twitch (or contract), or to go into spasm, when you don't want them to.Generally it leads to twitching around the eyes and lips.

Looking at your initial query,I thought that you are suffering from twitching of Masseter muscle which is due to Irritation of Trigeminal Nerve(5th cranial nerve)

It is not neccesary that a cancerous parotid tumor should first metastasize to surrounding tissues before affecting facial nerve.

Ultrasonogram(USG) and Fine needle aspiration cytology(FNAC) would help to reach at the diagnosis of Lump over Masseter muscle.

Hope this answers your query.Take care.
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. Vaishalee Punj
doctor
Answered by
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Dr. Riddhi Shah

ENT Specialist

Practicing since :2008

Answered : 533 Questions

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What Do Oval Lump And Twitching Of The Jaws Indicate?

Brief Answer: May need to consult Otolaryngologist and Neurologist Detailed Answer: Hi,thanks for your query, I have gone through your query. Hi,you might be suffering from following possibilities: 1.) HMS(Hemi-masticatory Spasm) is a rare unilateral movement disorder and characterized by paroxysmal contractions of jaw-closing muscles, such as masseter. Chewing, talking, and laughing are the most common triggers precipitating the spasm. Neurological examination is normal, except for the hypertrophy(enlargement) of the involved muscle or atrophy(reduction in size) in some cases associated with localized scleroderma(characterized by inflammation and thickening of the skin from excessive collagen deposition). The EMG(Electromyography) finding is helpful in the diagnosis and characterized by irregular bursts of motor unit potentials correlating with muscle spasms. The cause of HMS is not fully known and is considered to be owing to the result of a problem in the motor branch of the trigeminal nerve. In such a case ,it would be advisable to consult a Neurologist.MRI Brain may be required to know the cause.Medicines like gabapentin,Carbamazepine or Botulin injection may help in Muscle Twitching. 2.) Lymphnode enlargement-There are about 300 lymph nodes in the head and neck region Normally they are not palpable. During an infection or as a response to inflammation, these lymph nodes enlarge. However they rarely regress to their original size and hence remain palpable thereafter.You might be suffering from Lymphnode enlargement over Masseter muscle which may be of infective/inflammatory origin/or Cancerous. In such a case ,it would be advisable to consult an Otolaryngologist doctor to do ear,nose and throat examination and find out any cause of infection or inflammation or any cancerous growth. If the node is cancerous,then it would be hard,non-motile,more than 1 cm in size and it keeps on increasing in size. Looking at your description of swelling,it does not seems to be cancerous. I would advise you to go for Ultrasonogram (USG) and USG guided FNAC(Fine Needle Aspiration Cytology)-to find out the cause over swelling over your Masseter muscle. I would also advise you to quit smoking as it may lead to cancer of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach,etc. I hope my answer will help you, take care. I would be happy to answer if you have any follow-up questions.