6.4.4: 4. Clinical Evaluation- History and Examination
- Page ID
- 18325
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Objectives
- Avoid unnecessary surgery
- Do appropriate surgery
- Avoid embarking on surgery that is beyond the scope of a surgeon e.g. tumour requiring neck dissection
- Distinguish between submandibular lymph node and salivary mass
Distinguishing lymph node from SMG mass
- Unlike the parotid, there are no intraglandular lymph nodes
- Lymph nodes are lateral/superficial to the SMG
- Palpate the mass between a finger placed on the floor of mouth and another on the neck: lymph nodes are generally palpable only with the finger on the neck, as opposed to a SMG mass that is palpable between both fingers
- If still uncertain, proceed to U/S or FNAC
Suspicious for malignancy
- Malignant tumours may have benign clinical features in 2/3 of cases
- Rapid growth
- Pain (30% of malignant tumours)
- Extra-glandular extension
- Adherence to mandible
- Skin
- Floor of mouth
- Neurological deficits
- Hypoglossal nerve
- Lingual nerve
- Marginal mandibular nerve
- Cervical lymphadenopathy
- Previous salivary cancer
- Previous radiation to salivary gland region