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What is meant by some reactive enlarge lymph nodes in submandibular and parotid glands?

Answered by
Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2551 Questions

Posted on Fri, 11 Jan 2013 in Ear, Nose and Throat Problems
Question: Dear Doctor,
Please guide for following what does it mean-
1.There are some Reactive Enlarge Lynph nodes in submandibular and parotid glands? they are also extended to upper neck.
2.Left submandibular gland shows a slight mollted texture?
3.Changes are noted in both glands.
4.Does such changes are due to Virus OR Inflamation or they are of some Cancer?
Always some sour XXXXXXX feeling in throat.
5.Does these changes will effect gums also, feeling that gums of both jaws are getting/going towards downward and getting streched, while brushing some blood stains are also appearing, should I consult Dentist/ what should I ask Dentist/
6.What do you think that should I need further study?
7.Under left ear some small nodule is feeling too.
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for your query.

1. Get a Doppler study of the lymph nodes in the neck.

2. Normal salivary glands have a homogeneous appearance. A mottled appearance may signify a chronic inflammation or an auto-immune process since you have a history of diabetes and thyroid problems and the appearance is in both glands.

3. You may get a USG guided FNAC (Fine Needle Aspiration Cytology) done of both the salivary glands and a sample lymph node. Before any cancer, i would think of age related changes, dental problems, chronic inflammation and auto-immune reactions.

5. Sourness in the throat may be due to dryness or acid reflux. Bleeding from the gums may be due to Vitamin C deficiency. have multivitamin supplements. Get routine blood tests and a dental check up (to rule out gum disease) done.

6. We can discuss the options after the test results. The small nodule under the left ear should have shown up on the USG. It is most likely to be another reactive lymph node or a parotid gland swelling.

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

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Sumit Bhatti 20 hours later
Dear Dr.Bhatti,
Thanks a lot for your informative reply.Please guide that what is expected from gum disease, what questions are for Dentist, in Canada Dental is super commercial, does for gum disease Dentist is supposed to undertake any tests. For auto immune reactions as you what are those-does any tests required?
What is meant by reactive lymph node?
I am enclosing one year old parotid, do you suggest any further tests?
Here Many times even Ultra sound reports reading are not correct.
I have already done blood tests you can please name those I can send those reports in case I have.
Sleep Specialist noted following-
HEENT,nasal alae are symmetric.Nasal septum is mildly deviated to the left, He presents with with an erythematous left inferior turbinate. He presents with narrow high arched palate with modified mallampati score of 4, There is significant edema and erythema of the uvula and soft palate.
You can please clarify of all points mentioned by him.
ENT doctor here have sent for ENT surgeon, in start he is asking surgeries of throat then afterward he is confused and not clear that whether those surgeries will be of help or not.
Can you guide for available treatment option of Obs, sleep apnea in case I was not able to use CPAP.Doctors here are puting whole blame for each and every ailment on Sleep Apnea. I will send sleep study reports with lung fuction test to evaluate that my sleep study is suitable for CPAP or BPAP. in case you required those reports.
medicine list is enclosed ,Venafaxin is for depression as prescribed by sleep specialist, one doctor is suggesting MODAFINIL,he is also not clear to prescribe or not, please guide should I ask for this and should I substitute Venafaxin with this MODAFINIL .
Answered by Dr. Sumit Bhatti 14 hours later

Thank you for writing back.

1. Gum disease or periodontitis can be diagnosed on symptoms, examination and probing.

2. A full set of blood tests will be required to detect any auto-immune problem. The tests are many and the combination varies according to the auto-immune disorder suspected. Such tests may include routine blood and urine tests, ESR (Erythrocyte Sedimentation Rate) , C-RP (C Reactive Protein), RA (Rheumatoid Arthritis) Factor, XXXXXXX (Anti Nuclear Antibody) and so on.

3. A reactive lymph node is a benign, non-specific reaction commonly seen in lymph nodes due to a variety of causes as mentioned earlier.

4. From your attached report, the condition seems to involve all the salivary glands. You may get the USG repeated as this one is an old report and for comparison to see whether these changes are progressing.

5. What us your BMI (Body Mass Index)? You seem to have OSAS (palate and throat. You may share the reports here for an accurate assessment.

6. Venlafaxine is an anti-depressant and will not help in the treatment of OSAS. Modafinil is not an alternate to Venlafaxine. It is also not a substitute for OSAS.

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

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Sumit Bhatti 21 hours later
Dear Dr.Bhatti,
Enclosing sleep study done in hospital of full night, home sleep study report and lung testing report.
You can please guide-
Does Sleep apnea is of multi level obstruction as you noticed from previous reports.
Does this is Obstructive or Central sleep apnea, you will find that question XXXXXXX has been put after central sleep apnea.
Does for sleep apnea as per sleep study reports, which therapy is to be given like CPAP or BPAP, here doctors are not clear some are telling that CPAP is recommended other are telling that BPAP is recomended.
You will find that under lung fuction test it has been mentioned many times that it is very intersted study what does mean,
You can please clarify that what does report try to mention in different paragraphs.
Specialists /doctors here not bother to interlink all reports for proper treatment plan.
What do you suggest for my present reports- should i go for surgery and which one is recommended .
Does there is any other available treatment for my conditions, bacuse CPAP is hard to use on daily bases due to side effects like impressions on face of mask and chin strap. here they are doing more trials.
in which city you are working,

Answered by Dr. Sumit Bhatti 2 hours later

Thank you for writing back.

1. With a BMI of 39 or 42 and restrictive lung function there is bound to be an element of central apnea, though this would not change the treatment plan.

2. A CPAP machine maintains a constant pressure irrespective of the breathing cycle. A BPAP machine djusts pressures according to your breathing cycle. Hence BPAP is a better choice than CPAP.

3. Surgery is usually avoided above a BMI of 30 and undertaken on a case to case basis (beyond a BMI of 30).

4. There is no treatment for the restrictive lung function. What your doctor's find interesting is that there seems to be obstruction, especially in the supine position.
What is your weight ad height? Loosing weight is the best option. You may also consider bariatric surgery.

5. I practice in Pune, Maharashtra, India.

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

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Sumit Bhatti 3 hours later
Thanks Dr.Bhatti,
Your knowledge and expertise is great.
What is mean by
What your doctor's find interesting is that there seems to be obstruction, especially in the supine position.
This is good sign or bad.
Can you advise for LIPO INJECTIONS//lipo B injection to loose weight.which is latest technique advertised in this part of world.
Out of septoplasty and pharyngoplasty which one is recommended by you having good results for my conditions, and without any side effects.
Actually in case this was done in India then here in Canada doctors will raise their eyes.
Do you think that Adenoidectomy //deviated septum repair//tonsilectomy will give any relief in my case, what tests should be arranged to know these one.
my weight is 240 lb and height is 5'6'',main is belly weight.
Restrictive lung function has any treatment //medicines available and --does this is a serious one.

Thanks again
Answered by Dr. Sumit Bhatti 38 minutes later

Thank you for writing back.

1. Your doctors feel that there is some obstruction that is treatable. This is a good sign.

2. What are the exact contents of the Lipo B injection that you are planning to take? These predominantly contain Vitamin B6, Vitamin B12 and amino acids.The results may vary according to the exact contents.

3. How has your DNS (Deviated Nasal Septum) been diagnosed? Have a plain CT PNS (Para Nasal Sinuses) been done? If not, get it done and post the images (not the report).

4. Septoplasty may work. Pharyngoplasty is avoidable at present as it has several side effects. Besides the Mallampati Score, you should under go a flexible nasopharyngoscopy and a dynamic sleep MRI Scan.

5. Adenoid tissue normally disappears by the age of 15 years. Tonsils must be physically observed. The adenoid tissue and DNS will show up on CT PNS.

6. Your BMI is around 39.

7. Mild restrictive lung function is due to obesity and requires no treatment.

8. The dromedary hump on the left kidney is a normal indentation caused by the spleen. A prominent dromedary hump means an enlarged spleen or kidney or it may be normal. Get a CT abdomen if the Ultrasound is not clear. It will settle the issue.

9. Post void residue is due to prostate enlargement and a volume below 50 ml is not significant.

10 Overall. your surgical options are limited and a BPAP trial is a must. Weight loss is a top priority.

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

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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