Lymphadenopathy is a common clinical finding for patients seeking dental
treatment. It might be local, limited, or general1. Cervical
lymphadenopathy is thought to be caused by malignancies, infections,
autoimmune diseases, iatrogenic, and other miscellaneous conditions2,3.
More than half of the patients examined on a daily basis are likely to
exhibit enlarged lymph nodes in the head and neck area. The etiology of
cervical lymphadenoplasia is varied, so treatment differs from patient
to patient 4.
1E-mail:
sghaier.jihed25@gmail.com
2E-mail:
afef.1604@yahoo.fr
3E-mail:
doc_hamdi@yahoo.fr
Most cervical lymphadenopathy is caused by a benign infectious etiology;
nevertheless, doctors should look for a precipitating reason and examine
additional nodal sites to rule out generalized lymphadenopathy.
A 60-year-old female reported to the Department of oral medicine and
oral surgery at the University Dental Clinic of Monastir-Tunisia with a
complaint of painless swelling of 5 days duration on the right side of
the neck, specifically in the jugular-carotid region, with an
inflammatory aspect.
The patient had diabetes and dyslipidemia and was being regularly
treated and followed up by her primary care physician. No history of
weight loss or difficulty in swallowing or breathing. There were no
dysphagia, dysphonia, laryngeal dyspnea, or night sweats. He reported no
relevant history, treatment, known allergy, alcohol or nicotine
intoxication, or toxin consumption.
Family history showed no recent infections.
The patient presented swelling on the upper part of the right side of
the neck, measuring approximately 5 × 3 cm in size.
On palpation, the swelling was mildly tender, firm, nodular, and mobile
with smooth intact overlying skin without any signs of inflammation or
infection.
Examination of the contralateral side was unremarkable.
Patient consent was obtained for taking a photograph and using it for
study and publication purposes [Figure 1].
[Figure 1 about here.]
Intraoral examination revealed poor oral hygiene with the presence of
local factors and signs of periodontitis. However, most notably, the
right maxillary third molar is decayed and necrotic (fig2).
[Figure 2 about here.]
Panoramic radiograph revealed decayed right maxillary third molars,
generalized horizontal bone loss, and endodontically treated 31,
32,33,43,45,46 with crowns [Figure 3].
[Figure 3 about here.]
Thus, a differential diagnosis of cervical lymphadenopathy due to
locoregional infection, toxoplasmosis, and tuberculosis was given by
history and clinical examination.
Results of the blood investigations included a raised C-reactive Protein
(CRP) of 8.1 mg/l and raised Erythrocyte Sedimentation Rate (ESR) of 35
mm 1st hour and 73 mm 2nd hour.
Tuberculin skin test (TST) was negative after exposure to smear-positive
tuberculosis.
An ultrasound scan of the neck showed a right-sided, ovoid, well-defined
adenopathy of group III, heterogeneous, hypoechoic, with preserved fatty
hilum and non-vascularized
on color Doppler, measuring 19x9 mm. It is associated with infiltration
and hyperemia of the surrounding soft tissues on color Doppler. No signs
of necrosis and no visible calcification (fig4).
[Figure 4 about here.]
All the investigations were suggestive of benign Reactive adenitis of
dental origin.
Then, the Extraction of the third molar of the right side was performed
under antibiotic coverage with a combination of amoxicillin and
clavulanic acid (1000 mg twice a day).
Swelling completely resolved within the first 10 days of the therapy.
But treatment continued as per the protocol. After 20 days of follow-up,
she was perfectly all right (fig5).
[Figure 5 about here.]