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What does deranged submandibular gland indicate ?

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ENT Specialist
Practicing since : 1991
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Hi! i just had a CT scan done on my submandibular gland because it is swollend and very hard. My tongue started become really sore on one side and I have episodes of numbness in my face. I had thyroid cancer four years ago. The CT looked normal but something is not right with my gland and face. What step do i need to take next?
Tue, 17 Apr 2012 in Cancer
Answered by Dr. Sumit Bhatti 1 hour later
Dear Kclaybrook,

Thank you for your query.

I would like to ask you some more details on the problem you have to arrive at a better opinion for you :

1. What was the histopathological diagnosis of the thyroid tissue removed four years ago? It is rare for thyroid cancer to spread to a submandibular salivary gland. Which sides are involved?
2. Did you also receive Radioiodine ablation after your thyroid surgery? Radioiodine may damage salivary tissue and this could be a late manifestation.
3. The differentiation of your submandibular gland swelling from isolated submandibular sialadenitis and the thyroid cancer will require:
a) USG (ultrasonography) with a 4D scanner equipped with a color doppler. I would like to differentiate between lymph nodes, salivary gland tissue, residual thyroid tissue, necrosis or calcification (which indicate malignancy).
b) CT with contrast or MRI.
c) FNAC (Fine Needle Aspiration Cytology), which may be USG guided. An excisional biopsy with Immunohistochemistry / Tumor markers may be performed.
d) Sialogram, x-rays to rule out a calculus or duct stone.
e) MRI with new special contrast agents such as Supraparamagnetic Iron Oxide (SPIO) or Ultrasmall Superparamagnetic Iron Oxide (USPIO) is now available in research hospitals across XXXXXXX
4. Do you have dryness of mouth? This may indicate deranged submandibular gland function. The soreness of tongue and numbness of face is a sign of local inflammation affecting the tissues and nerves near the gland.
5. The possibility of a second primary or distant metastasis should be kept in mind. I hope that it is only a sialadenitis.

Anticipating your response.

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