Facial Swelling as a Primary Manifestation of Multiple Myeloma

Abstract

Facial swellings are commonly encountered in the dental office, the cause of which could range from a congenital etiology to an acquired one or it may even be a manifestation of an underlying systemic disease. The clinician must have a thorough knowledge of the various clinical and imaging manifestations and the sites of occurrence of the various conditions to arrive at the appropriate diagnosis. Facial swellings can be classified into different groups which include acute swellings with inflammation, nonprogressive swellings, and slowly or rapidly progressive swellings. The various imaging modalities like CT and MRI are useful for assessing the extent of the swelling as well as evaluating the soft tissue and osseous involvement of the swelling. Multiple myeloma represents clonal proliferation of plasma cells and is a condition in which a facial swelling might be present, though not common. This paper reports a case of a patient with a unilateral facial swelling, which on investigation led to a diagnosis of multiple myeloma.

Educational Case: Diagnostic Approach to Salivary Gland Neoplasms

“…Rapidly progressive swellings are usually associated with malignancies. 2,3 Acute sialadenitis is inflammation of salivary glands due to bacterial or fungal infection, or secondary to obstruction by salivary gland stones (sialolithiasis). Acute lymphadenitis is an inflammation of the lymph nodes usually due to bacterial or fungal infections too.…”

Evaluation of oral and maxillofacial swellings using ultrasonographic features

“…Computed tomography (CT) and magnetic resonance imaging (MRI) are recent imaging tools that are often used to clarify maxillofacial lesions' nature, extent, boundaries, and effect on the surroundings, but they remain expensive and have limitations. Ultrasonography may overcome these disadvantages of CT and MRI 67…”

Multiple Myeloma Presenting as a Parotid Mass

“…1 With a male predilection, the average age of Multiple Myeloma at diagnosis is around 60 years old. 5 Normally, plasma cells become B-cells when exposed to pathogens and produce antibodies. However in Multiple Myeloma, plasma cells generate clones of itself and form tumors eventually interfering with normal cell production and function.…”

“…8 Since the malignant cells come from a common precursor, the antibodies produced are identicalmonoclonal immunoglobulins (M-proteins) are then released into the blood and urine giving the symptoms and becoming targets for diagnostic examinations. 5 Multiple myeloma usually present with bony or intramedullary lesions. Extramedullary plasmacytoma is an uncommon presentation with predilection for the upper respiratory tract; if ever it occurs in the head and neck region, soft tissue plasmacytomas tend to involve the nasal cavity or nasopharynx.…”

“…1 Its occurrence in the salivary glands is singularly rare 9 with only 24 published cases since it was first reported in 1965 up until 2017. [2][3][4][5][6] The patient presented with a one (1) year history of a slowly enlarging left pre-auricular mass, with no other accompanying symptoms and no intra-oral involvement -the common presentation of pleomorphic adenoma which is a benign parotid tumor. Routine imaging in patients with well-defined superficial lobe masses is not warranted because the result will not change the treatment plan.…”