Dental Causes of Cervicofacial Lymphadenitis

Introduction

The enlargement of lymph nodes would either be iatrogenic (of unknown cause) or have infectious pathogenic causes; this condition is termed "lymphadenitis" in the body. Inflammation or infection of the lymph nodes would possibly occur, not only because of the increased size of the lymph nodes but also due to the infections in the body. Yet, it is easily associated with many clinical symptoms in the affected patients which can range from localized pain (of lymph node swelling), skin changes, localized or generalized edema, and low or high-grade fever. This often involves a purulent discharge in the form of exudate as well.

What Is the Classification of Cervicofacial Lymphadenitis?

In general, lymphadenitis is usually classified into three forms based on the duration.

1. Acute Cervicofacial Lymphadenitis - The acute form of lymphadenitis is when the infection or swelling lasts up to two weeks.

2. Subacute Cervicofacial Lymphadenitis - The subacute form is when the infection lasts two to six weeks.

3. Chronic Cervicofacial Lymphadenitis - This form of lymphadenitis is when the infection persists for over six weeks.

This classification is a general rule for diagnosing the disease process adopted by physicians, pediatricians, and dentists. However, this is not categorized as such in the medical literature of lymph node swellings since the symptoms would fall into more than one set of categories mentioned above, which are not only related to duration but also based upon the presentation of clinical symptoms.

What Are the Clinical Features and Pathology of Cervicofacial Lymphadenitis?

There would indeed be a wide variety of clinical symptoms associated with the usually "acute cervical lymphadenitis" in the neck region. This induces a cascade of abnormal events occurring quickly and immediately, distant from the head and neck. The condition can also be linked to dental infection. Acute cervical or acute cervicofacial lymphadenitis would result in the localized swelling or edema of the tissues of the neck, hyperplasia (increased rate of division, causes an increase in tissue or organ) or proliferation (multiplication) of the lymphocyte cell, increased leukocyte cell infiltration, and even result in more of the chemotaxis (cell movement in response to chemical stimuli) process that is responsible largely for the nodal enlargement in the neck.

The features of cervicofacial lymphadenitis are:

1. This state of inflammation further triggers the local release of many cytokine molecules, eventually initiating several other cellular signals that tend to induce vasodilation (expansion of vessels) and capillary leak of cells.

2. Further erythema (redness) and edema (swelling) superficially in the protective skin layers would be extremely common in this condition.

3. The most common clinical symptom that younger children or younger adults often report in cases of acute cervicofacial lymphadenitis is local pain in the neck region, where the tenderness is most likely due to the bloated nodal capsule of the affected lymph node.

4. Multiple factors affect lymph inflammation, including the patient’s age, the course of the disease, the time span of persisting lymph nods, any associated symptoms such as zoonosis (infection transmitted from animals to humans), and previous travel history when the inflammation is triggered.

5. In neonates and infants, lymphoceles (a collection of lymphatic fluid in a cavity not lined by epithelium) are most likely the infection sites, mainly caused by Toxoplasma gondi.

6. Sexually transmitted diseases would be possible causes of inguinal lymphadenopathy in young adolescents. Viral infections tend to cause bilateral lymphadenopathy in the case of upper respiratory tract viral infections (i.e., commonly influenza or adenovirus). generalized lymphadenopathy in young adults would be a result often because of affliction with the EBV (Ebola virus) or CMV (Cytomegalovirus) virus infections.

Can Oral or Dental Infections Cause Lymphadenitis?

Lymphadenopathy anywhere in the body would be described as a condition primarily characterized by irregularity in the size and texture of your lymph nodes. This condition is extremely common in childhood and is considered harmless, usually due to several etiologic factors. The most prevalent of these causes would be either a local or generalized infection. At the same time, autoimmune and neoplastic or malignant processes are rare or extremely less frequent causes in the pediatric population. It would be interesting for the oral and maxillofacial surgeon, the dentist, the pediatrician, and the physician to note that almost 45 to 57 percent of healthy children across the globe (according to current medical statistics) usually have palpable lymph nodes. In contrast, around 90 percent of healthy children aged between four and eight would be prone to upper respiratory tract infections.

Palpation of the lymph nodes is an important and routine part of a child’s or adult's physical examination. Cervical lymphadenitis is mainly related to Streptococcal pharyngitis infection or a submandibular node enlargement, most commonly caused by dental or oral disease, the causes of cervical lymphadenitis in children, adolescents, and young adults. Definitive diagnosis of cervicofacial lymphadenitis is always based either on histological or microbiological investigations through the PCR (polymerase chain reaction), and cultures of the lymph nodes involving excisional biopsy would be the treatment of choice for cervical lymphadenopathy caused by atypical mycobacterium. Submandibular or submental lymphadenopathy, on the other hand, is usually caused by oral or dental infection.

How Can Lymphadenitis and Cancers Differentiated?

The oral surgeon or the physician should differentiate these superficial lymphadenitis infections from the palpable lymph nodes in the supraclavicular area. When the supraclavicular lymph nodes may be painful or palpable, a differential diagnosis is needed to check for any possible malignancy. Differential diagnosis in supraclavicular lymph node swellings would include, apart from cancer, even certain sexually transmitted diseases or neonatal or congenital infections.

What Is the Management of Cervical Lymphadenopathy?

1. Surgical management is indicated only when there is a suspicion of cancer or malignancy in the lymph nodes.

2. Most children with cervical lymphadenopathy would not require any specific treatment except an antibiotic prophylaxis regimen. Still, follow-up would be needed to eliminate the infection in two to four weeks. Treating acute bacterial origin cervical lymphadenitis involving primary infectious sources should involve adequate antibiotic coverage for both S. aureus and S.pyogenes bacteria.

Conclusion

Clinical history is most important and needs to be elicited efficiently by the oral and maxillofacial surgeon, the dentist, the pediatrician, the general physician, and the otolaryngologist. For children between three and five years old, upper respiratory tract infections are the most common cause of cervical lymphadenitis, followed next by the probable causes of pharyngitis (inflammation of the pharynx), otitis (painful inflammation of eardrum), or conjunctivitis (dryness in eyes). In these common conditions resulting from viral infections in children, reactive cervical or submandibular lymphadenopathy would be extremely common.