Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

880 Jaw Swelling and Masses

IRV), Malignant (Mucoepidermoid Carcinoma, Adenoid Cystic Car-

cinoma, Malignant Mixed Tumors, Adenocarcinoma).

■Submandibular Masses (50% benign, 50% malignant): same patho-

logical types as for parotid tumors.

■Lymphoma

■Squamous Cell Carcinoma

■Nasopharyngeal Carcinoma

Infectious Masses

■Salivary Calculi: duct stones in Stensen’s or Wharton’s duct

■Dental infection

■Cat-Scratch Disease

■Atypical Mycobacterial infection

■Tuberculosis

■Actinomycosis

■Bacterial Adenitis

■Kikuchi’s Disease

■Kawasaki’s Disease

■Castleman’s Disease

■HIV

management

■Directed tests such as endoscopy in the office, computerized imag-

ing, and FNA with cultures are usually the studies that will signifi-

cantly narrow down the diagnosis.

■Patients with infectious masses are often admitted to the hospital for

IV antibiotics if the infection is acute, while more chronic infections

can usually be treated on an outpatient basis with oral antibiotic

coverage as directed by the diagnosis.

■Neoplastic conditions and congenital masses are often worked up

on an outpatient basis.

specific therapy

Congenital Masses

■Branchial cleft cysts are usually excised.

Hemangiomas often regress at about 18 months of age and regres-

sion can occasionally be hastened with steroids.

Lymphangiomas can be excised and/or sclerosed.

Low-flow vascular malformations can be sclerosed.

High-flow lesions can be treated via intra-arterial occlusion with

or without excision.