Cervical Lymphadenopathy:

Highly important to the dental practictioner

Localized, limited or generalized form. - 3 forms
Causes - may be malignancies, infections or autoimmune disorders.

Unexplained cervical lymphadenopathy - serious cause it can imply malignancy

Methodological approach important.

Lymph nodes : Oval shaped organs, linked by lymphatic vessels

Functions: Antigen PRP : presenting, processing and recognition

Types of Lymphadenopathy: Hyperplastic or Infiltrative

Hyperplastic: immunologic or infective
Infiltratice: Cancer/metastases, lipid or glyco laden macrophages

Drug induced:
1. Anticonvulsants
2. Sulphonamides

Any abnormality in size, consistency and number is defined as a lymphadenopathy

This is caused by the invasion of inflammatory cells or neoplastic cells into the lymph nodes
Lymphadenopathy: 1. Localized. 2. Generalized. 3. Dermatopathic

Can be : Acute - 2 weeks duration, Subacute - 4-6 weeks duration and Chronic - does not resolve by 6
weeks

Important to differentiate localized and generalized lymphadenopathy

A patient with a palpable lymph node in the neck : serious diagnostic an therapeutic problem.

Head and neck: most common site for lymphadenopathy

Infection is the most common reason for lymphadenopathy
Of which, tuberculosis and filariasis are predominant in india

Can also be due to malignancies or lymphadenitis

Filariasis: 1. Asymptomatic filariemia, 2. Recurrent lymphadenitis, 3. Chronic lymphadenitis, 3. Scrotal

swelling

Lymphadenopathy is explained by identifying regional injury or infection.

Most concern of malignancy is when there is no regional lymphadenopathy

Lymphomas are malignant lymphoproliferative diseases - HL or NHL

Regional cervical lymphadenopathy - recent onset - yes : URTI, Tonsillitis, Dental infection, Kawasaki
disease, Bacterial lymphadenitis
Persisting localized : infectious mononucleosis, TB, cat scratch disease, atypical mycobacteria

1. Limited
2. Localized - acute/persistent
3. Generalized

Acute, Subacute, Chronic

Persistent:

1. Atopic Eczema: Significant persistent, prominent in posterior part of neck

2. Infections : EBV/IM - generalized lymphadenopathy and hepatosplenomegaly
3. MAC : non tender, violaceous hue seen. systemically well. Unilateral
4. Tuberculosis: Non tender, systemic features
5. Cat scratch - tender, axillary lymph nodes

Malignant:
1. Lymphoma : HL, NHL
2. Leukemia : ALL, AML, CML

Rheumatologic conditions:
Juvenile chronic
SLE - Kikuchi Fujimoto disease : tender lymph nodes, associated fever. role of HIV, HTLV, EBV.
Apoptotic cell death

Diagnostic tools:

1. FNAC
2. Ultrasonography
3. CT, PET CT

Standard modality: using FNA - for cytology and culture

Unkown primary?

Causes:

1. URTI :

Can lead to bilateral swelling

Can be due to dental infection or tonsillar or bacterial/viral
Bacterial : GABS, staph infection
Bilateral, warm erythematous swelling.
Bacterial testing useful
Abscesses - dental abscesses can cause cervical lymphadenopathy
2. Cat scratch disease:
Bartonella,
Tender lymph notes
antibodies against Bartonella
Parotid and submandibular
Fever

Location of lymphadenopathy:

1. Cervical group are commonly involved

2. Submandibular or submmental are involved in cases of oral and dental infections
3. Lymphomas infect both the above
4. Preauricular: Rubella, cat scratch
5. supra scapular: Suspect malignancy
6. Suboccipital : scalp infections

Scrofula: Tubercular lymphadenopathy:

Tuberculosis
hematogenous or lymphatic dissemination of pulmonary Tb or reactivation of latent Tb or the primary
involvement of adenoids or tonsils

Etiological agent:
M tuberculosis
MAC complex
Scrofula is more common in women than in men

Pathophysiology:
Most cases of peripheral lymphadenopathy due to reactivation of latent Tb
Tubercle bacilli are through droplet or milk
Pathogenitcity: virulence of bacteria, metabolic factors
Depends on host factors
Weakened immunity - dissemination
Macrophages play a central role in host cell immunity

Clinical manifestation of scrofula - miliary TB

Mostly: subacute or chronic
Subacute: weight loss and failure to thrive
Fever, rigors and night sweats

Management:
Fan - microscopy reveals giant cells, granuloma, mycobacteria
HIV to be determined

Mycobacterial culture: Definitive diagnosis depends upon the isolation and identification
Using off based agar/Lowenstein Jensen medium

Excisional:
Technique with higher morbidity
More invasive.
FNA/FNA wihth ultrasound guide are not available
Imaging:

CT, differentiate scrofula from other metastatic cancer or lymphoma

Mantoux text

Treatment:

Anti tubercular drugs:

IREP:

5, 10, 15, 25 daily orally for 2 months

Multi drug resistant Should be treated for 18months