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Head and Neck Cancer

Nodule in left parotid gland?

11/19/2008

Question:

Dear Sir/Madam,

Iam a 28 year old healthy male. Since past 1 month, I have this small tumor/ lump under my left cheek, above the jaw bone. I can feel it only if I press the skin on my cheek.

Earlier it caused some pain, when pressed, and the pain has now totally subsided after last 7 days of anti-biotics (Feronem 200mg) suggested by my general physician. Although I feel that the size of the tumor has not reduced.

I sought opinion from a General Surgeon who advised a CT scan. The findings of the CT were as under :-

"There is a tiny 8x6 mm sized nodule in the superficial lobe of the left parotid anteriorly which is of uncertain etiology and maybe a small intraparotid lymphnode and needs further evaluation. No other significant abnormality is seen in the neck."

All my other diagnostic tests (Blood test, etc) were absolutely normal. My surgeon had suggested a excission biosopsy to investigate this matter further. As it is painless and causing me no major discomfort I would prefer to wait for some more time before deciding on a surgery (specially since it is located in a sensitive region).

Please advise if it would be ok to wait for a month or two, before I go ahead with this surgery. Are there any other diagnostic test which I can take to have a more accurate diagnosis of this? Should I continue with anti-biotics for some more time?

Answer:

A lump in this area is never normal. It seems to have responded to antibiotics and therefore it would not be unreasonable to continue with them for a little longer. Any mass of any size in the parotid is suspicious for a neoplasm that is more often benign but could also be malignant....if it does not disappear a biopsy would be indicated. This is usually done with a fine needle aspiration. If the fine needle in inconclusive or suggest a neoplasm and not a node, surgical excision should be performed. You would require a parotidectomy. It is important that this be done by a surgeon familiar with this type of surgery. The major risk of this surgery is injury to the facial nerve which provides the motor innervation of the face.

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Response by:

Pierre  Lavertu, MD, FRCS(C), FACS Pierre Lavertu, MD, FRCS(C), FACS
Professor of Otolaryngology-Head and Neck Surgery
School of Medicine
Case Western Reserve University