JAW SWELLING

Applying anatomy, one can quickly ascertain that a lump in the jaw may come from the skin and subcutaneous tissues, glands, or bones.

1. Skin and subcutaneous tissue. This will remind one of lipomas, fibromas, and sebaceous cysts, although cellulitis and carbuncles may occur too. Other skin masses are discussed on page 396.
2. Parotid gland. Important lesions here are mumps, Mikulicz syndrome in Hodgkin lymphoma, Behçet disease of uveoparotid fever, and mixed tumors of the salivary gland. A stone in the Stensen duct may cause intermittent swelling of the parotid gland. Parotid gland swelling is also a component of Sjögren’s syndrome.
3. Jaw bone. These are best divided into etiologic groups using the mnemonic MINT.
4. M—Malformations include congenital protrusions of the jaw, acquired protrusion from acromegaly, and thickening of the jaw in Paget disease.
5. I—Inflammation suggests alveolar abscesses, osteomyelitis, actinomycosis, tuberculosis, or syphilis.
6. N—Neoplasms include osteomas, adamantomas, sarcomas, myelomas, metastatic carcinomas, and odontomas.
7. T—Trauma obviously can cause severe fracture dislocations, subperiosteal hematomas, and dislocation of the jaw. It is worthwhile to mention that hyperparathyroidism may cause cystic lesions of the jaw (generalized osteitis fibrosa cystica).

Approach to the Diagnosis

The approach to the diagnosis is to obtain x-rays of the jaw and teeth; ascertain calcium, phosphorus, and alkaline phosphatase levels; and perform biopsy and excision when indicated. Sialography and bone scans may be useful in selected cases. It is wise to consult a dentist at the outset.

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Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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