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Q. My unilateral submandibular lymph node swelling does not reduce even after antibiotics. Why?

Answered by
Dr. Mohammed Osama Aboborda
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 04, 2020

Hi doctor,

I have a unilateral submandibular lymph node swelling on the right hand side of the neck. I had an ultrasound and at this time the lymph node measure 5-6 cm and the onset were sudden with pain. After three-course of antibiotics (Augmentin two doses and Clindamycin one dose), I was referred to have another ultrasound. This was after two months of the initial appearance of the lymph node. This ultrasound scan showed the lymph node had become 3 cm but was still present. So the doctor ordered FNAC. The results of this have come back and there is no sign of metastasis or no sign of TB lymphadenopathy. The doctor has suggested yet another course of antibiotics of Doxycycline and remeasure the Lymph node after three weeks. The FNAC said it was an inflammatory lymph node. Does this mean reactive lymph node? What else could be causing this?

Dr. Mohammed Osama Aboborda

Otolaryngology (E.N.T)
#

Hi,

Welcome to icliniq.com.

I want you to be completely calm because according to the course of the lymph node enlargement, symptoms, and investigations the lymph node enlargement is just an inflammatory reaction. It is not a tumor at all.

Just complete your antibiotic treatment then follow up on the lymph node again just for assurance. The lymph node may decrease in size but never comes to its normal size again. This is normal.

Now about causes, any neck, mouth, or pharyngeal inflammation can cause inflammatory enlargement of a submandibular lymph node. Even without the previously mentioned inflammations, a submandibular lymph node inflammation can start by itself as the lymph node works as a filter for the blood picking up pathogenic microorganisms.


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Thank you doctor,

The recommendations given were potentially to remove this lymph node if is does not decrease in size or carry out excisional biopsy. Would you recommend this? Please explain what you would recommend? Also, in terms of causes what you have mentioned was it is normal for the swollen lymph node to still be there after two months? My concern is the duration.

Dr. Mohammed Osama Aboborda

Otolaryngology (E.N.T)
#

Hi,

Welcome back to icliniq.com.

I recommend excisional biopsy if it does not decrease in size. I meet cases with inflammatory lymph node enlargement which increases and decreases in size or even stable in size for (years) not for only two months.


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