Submandibular lymph nodes: analysis of 37 cases. From 1998 to 2002, I analyzed the causes of submandibular lymphadenopathy in 37 cases as follows:
1 Clinical Data
1.1 Average data: All 37 children were outpatients at our hospital, including 21 males (57%) and 16 females (43%). The age distribution was as follows: 1-3 years old in 6 cases (16%), 4-7 years old in 17 cases (46%), 8-10 years old in 9 cases (24%), and 11-14 years old in 5 cases (14%).
1.2 Clinical manifestations:
Position and size: Located anterior and superior to the mandible and sternocleidomastoid muscle, palpable subcutaneous masses with a hard texture were found. There were 12 cases of unilateral lymphadenopathy and 25 cases of bilateral enlargement. Diameter less than 1 cm in 18 cases (49%), diameter less than 2 cm in 13 cases (35%), and diameter greater than 2 cm in 6 cases (16%).
Pain: The majority had varying degrees of pain; younger children refused to touch the local area or cried when touched, while older infants showed oral tenderness during examination.
Fever: Among the 37 cases, 25 cases had fevers ranging from 37.6°C to 40°C. Of these, 18 cases sought medical treatment due to fever, and 7 patients sought treatment due to pharyngeal pain. Observation of temperature revealed remittent fever.
Other: Due to submandibular lymphadenopathy, some children experienced oral or tonsillar inflammation leading to saliva production, local oral pain, and difficulty breastfeeding, making it impossible for them to eat. Some older infants lost their appetite due to pain, while younger infants could also be affected.
1.3 Laboratory tests: Among the 37 cases, 29 cases had peripheral white blood cell (WBC) counts greater than 10×10^9/L, with neutrophils ranging between 0.7 to 0.85 in most cases. Peripheral blood tests were normal in more cases.
1.4 Treatment: In each case where peripheral WBC count was elevated, antibiotic therapy was given either intramuscularly or intravenously, along with symptomatic treatment for fever and pain. In this group of 37 cases, after treatment for 5-10 days, the original disease was cured, and the lymph nodes reduced to normal size, with disappearance of pain and fever.
Results: 1.5 According to the primary disease, the causes were analyzed (see Table 1). From Table 1, it is evident that younger age groups had a higher incidence. Among the 37 cases, preschool children (<8 years) accounted for 23 cases (62%). Respiratory tract infections (tonsillitis and pharyngitis) were the primary factors causing submandibular lymphadenopathy, with an incidence of 20 cases (54%). Upper respiratory tract infections in preschool children occurred in 20 cases, with 15 cases (75%) being related to respiratory infections.
Secondly, oral cavity diseases (periodontitis and cavities) were the second factor causing submandibular lymphadenopathy, with a pathogenesis rate of 10 cases (27%). Epidemic diseases (mumps) caused submandibular lymph node enlargement in third place, with an onset in 6 cases (16%). Unexplained submandibular lymphadenopathy occurred in only 1 case (3%).
Discussion: Lymph nodes are an important part of the reticuloendothelial system. In local lymph node inflammation, enlargement often occurs due to stimulation by pathogens and their toxins, which may lead to suppuration, necrosis, and indicate possible disease occurrence. In this group of 37 cases of submandibular lymphadenopathy, 36 cases (97%) were caused by primary diseases. Since this group of cases occurred in early spring, the climate was dry, cold, and changeable, and this season is the epidemic season for respiratory diseases and certain infectious diseases. Young children, especially young infants, have low airframe resistance and find it difficult to adapt to this season after winter, leading to an increase in morbidity of upper respiratory tract diseases and infectious diseases, resulting in an increased incidence of submandibular lymphadenopathy due to the original disease.