Last week, one of my recall patients had concerns about a swollen, painful lump in her cheek/TMJ area. Sandra suffers from severe Sjogrens disease and has had significant dental decay and mouth sores as a result.
The extra oral exam revealed bilateral hard palpable masses. The right side was the size of a marble and the left was considerably larger, about the size of an egg. With Sandra’s permission, I took a panorex to further evaluate the suspicious areas. Although the images were light, I could certainly see the round masses. My initial thought was a clogged Stenson’s duct. We referred Sandra to an ENT for further evaluation. She was pretty nervous about going and was afraid she might have a tumor, so I offered to accompany her to her appointment.
It took less than 10 minutes for Dr. KC McGee to diagnose Parotiditis. With a tongue depressor, he was able to put lateral pressure on the inside of her cheek at the location of the parotid gland and express a large amount of thick greenish exudate from the Stenson’s duct. I had never seen anything like this. Due to the lack of saliva, the duct had become so dry that it basically closed up and the parotid gland became infected. He prescribed antibiotics and cultured the exudate.
I called Sandra later that evening to see how she was doing. She had been keeping warm, moist compresses on her cheeks and had had more drainage through out the day. She was sore but was relieved to know she didn’t have cancer.
Lumps and bumps come in different shapes and sizes. It is our professional responsibility to check each and every patient for intra and extra oral abnormalities. If a patient is fearful, you may have to literally hold their hand to get them to follow up on a referral. When in doubt, check it out. That’s my motto.
Welcome to my life.
Lisa
