Does anyone happen to know...

[Guest guest]

what this lump in my chin might be?? I get this hard, painful lump in my chin

that will last for a few days and then go away for a while. It hurts when I talk

and swallow. Actually, it hurts constantly, the pain doesn't let up at all, then

after a few days, it kind of disappears again. I'm guessing it a swollen gland

but I didn't know whether we have glands right there so close to the end of my

chin.

I'll try to explain exactly where it is... If I put my right index finger up as

if to shhh someone, and keep my thumb in line with my finger, my thumb touches

directly on it.

If anyone can clarify what this might be, I'd sure appreciate it. I've been

extremely busy lately and really stressed out. I'm heading out on a road trip on

Saturday, by myself with the kids. I have to meet my husband somewhere in

Alberta (it will take me two days of travelling with the kids and dog) Of course

everything else that could possibly go wrong this week has and I've been really

having a hard time handling my stress. I've been looking forward to this trip to

B.C. for a long time and now everything has seemed to turn on me, making it

really difficult.

Today, I went to Winnipeg (an hour from here) did a shop and came home. Half way

home my hips hurt so bad I had to prop myself up sideways. I was almost in

tears. Just an indication of how driving for 8 or 9 hours in a day is going to

be! Maybe I should try filling one of those little 'donut' things with water and

putting it in the freezer. Then I could have an icepack/seat cushion!

[Guest guest]

Onale,

Sounds like parotitis, parotid gland (salivary gland) swelling. You

describe intermittent pain and swelling with this which makes me wonder if

you have a parotid gland stone that is intermittently blocking.....

WHERE ARE SALIVARY GLANDS?

The glands are located in and around the mouth and throat. The major

salivary glands are called the parotid, submandibular and sublingual glands.

They all secrete saliva into the mouth: the parotid through ducts near the

upper teeth, submandibular into the front portion under the tongue, and the

sublingual through multiple ducts in the floor of the mouth.

In addition to these glands, there are hundreds of tiny glands called minor

saliva glands located in the lips, inner cheek area (buccal mucosa) and

extensively in other linings of the mouth and throat. Salivary glands

produce the saliva used to moisten your mouth, initiate digestion, and help

protect teeth from decay.

WHAT CAUSES ABNORMAL GLANDS?

Abnormalities of the salivary glands which cause clinical symptoms can be

grouped as follows:

OBSTRUCTION: Obstruction to the flow of saliva most commonly occurs in

the parotid and submandibular glands, usually due to stone formation.

Symptoms typically occur when eating. Saliva production is initiated, but

cannot exit the ductal system, leading to swelling of the involved gland and

significant pain, sometimes with an infection.

INFLAMMATION: If stones are not totally obstructive, the major glands

will swell during eating and then gradually subside after eating, only to

enlarge again at the next meal. Infection often develops in the abnormally

pooled saliva, leading to more severe pain and swelling in the glands. If

untreated long enough, the glands may become abscessed.

In some individuals the duct system of the major salivary glands may be

abnormal. These ducts can develop small constrictions which decrease

salivary flow, leading to infection and obstructive symptoms.

INFECTION: The most common salivary gland infection is mumps, which

involves the parotid glands. While this is most common in children, it can

occur in adults. However, if an adult has swelling in the area of the

parotid gland on one side, it is more likely due to an obstruction or a

tumor. Infections occurring because of ductal obstruction or sluggish flow

of saliva have already been mentioned.

Secondary infection of salivary glands from adjacent lymph nodes also

occurs. These lymph nodes are the glands in the upper neck which often

become tender during a common sore throat. Many of these lymph nodes are

actually located on, within, and deep in the substance of the parotid gland,

near the submandibular glands. When these lymph nodes enlarge through

infection, this is noticed by the patient as a red, painful swelling in the

area of the parotid or submandibular glands. Lymph nodes also enlarge due to

tumors and inflammation.

TUMORS: Primary benign and malignant salivary gland tumors usually show

up as painless enlargements of these glands. Tumors rarely involve more than

one gland and are detected as a growth in the parotid, submandibular area,

on the palate, floor of mouth, cheeks, or lips. These enlargements should be

checked by an otolaryngologist head and neck surgeon.

Malignant tumors of the major salivary glands can grow quickly, are painful,

and can cause loss of movement of part or all of the affected side of the

face. These symptoms should be immediately investigated.

Salivary gland enlargement is also seen in auto-immune diseases, which cause

significant inflammation. Patients often have a dry mouth or dry eyes. This

may occur with other systemic diseases such as rheumatoid arthritis.

Diabetes may cause enlargement of the salivary glands, especially the

parotid glands. Salivary gland swelling (usually on both sides) is also seen

in alcoholics.

HOW DOES YOUR DOCTOR MAKE THE DIAGNOSIS?

The diagnosis of salivary gland disease depends upon a careful history, a

physical examination, and laboratory tests. If an obstruction of the major

salivary glands is suspected, it may be necessary to anesthetize the opening

of the salivary ducts in the mouth, and to probe, and dilate the duct to

help an obstructive stone pass. Prior to such instrumentation, dental x-rays

may show the location of calcified stones.

If a mass is found in the salivary gland, it is helpful to obtain an x-ray

called a CT scan. CT scans will show whether the mass is an actual part of a

salivary gland, or an associated lymph node.

In many cases a fine needle aspiration biopsy in the doctor's office is

helpful. The accuracy of this test is approximately 80% to 90%. An open

biopsy, where a skin incision is made and a small sample of the gland

removed, is not usually recommended in the office. This is an incisional

biopsy and because of the possibility of injury to underlying nerves within

the parotid gland may need to be done in the operating room.

TREATMENT OF SALIVARY GLAND DISEASE

Treatment of salivary diseases is broadly classified into two categories:

medical and surgical. Selection of treatment depends upon the nature of the

problem. If it is due to systemic diseases (diseases that involve the whole

body, not one isolated area), then the underlying problem process must be

treated. This may require consultation with other specialists. If the

disease process relates to salivary gland obstruction and subsequent

infection, antibiotics are used. Sometimes instrumentation of the ducts will

be needed.

If a mass has developed within the salivary gland, removal of the mass may

be required. Most masses in the parotid gland area are benign. When surgery

is necessary, great care must be taken to avoid damage to the facial nerve

which lies within this gland. When malignant masses are present in the

parotid gland, it may be possible to surgically remove these masses and

preserve most of the facial nerve. Radiation treatment will often be

recommended after surgery. This is typically administered four to six weeks

after the surgical procedure to allow adequate healing before irradiation.

The same general principles apply to masses in the submandibular area or in

the minor salivary glands within the mouth and upper throat. Benign diseases

are best treated by surgery alone, whereas malignant diseases may require

surgery and postoperative irradiation. If the mass in the vicinity of a

salivary gland is a lymph node which has become enlarged due to cancer from

another site, then obviously a different treatment plan will be necessary.

Such treatment can be very effectively directed by an otolaryngologist-head

and neck surgeon.

In summary, salivary gland diseases are due to many different causes. These

diseases are treated both medically and surgically. Such treatment is

readily managed by an otolaryngologist-head and neck surgeon with experience

in this area.

[Guest guest]

I was thinking the same t hing, Jill...remembering what Mark lamar went thru

several years ago. His got blocked by eating oysters, if I remember correctly.

A small piece of pearl/sand got into the duct...

Re: Does anyone happen to know...

Onale,

Sounds like parotitis, parotid gland (salivary gland) swelling. You

describe intermittent pain and swelling with this which makes me wonder if

you have a parotid gland stone that is intermittently blocking.....

[Guest guest]

Thank you very much for all the info Jill. Chances are I won't be able to get in

to get it checked out before my trip. I'm leaving early Saturday morning. The

last time I tried to see a doctor on such short notice, she said I'd have to

'walk in'. I was incredibly ill and I sat on a hard plastic chair in the waiting

room for 5 hours. After about 3 and a half hours, I had to go upstairs to ER and

get a shot of Demerol so that I could sit out the rest of the wait.

I'll call and see what they can do. Thanks again.