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CONSENSUS DIAGNOSIS: CIMDL
CONSENSUS CIMDL PROBABILITY (0–1, two decimals): 0.84
MERGED ITEMS (Q1–Q10):
Q1: Positive
Q2: Positive
Q3: Positive
Q4: Positive
Q5: Positive
Q6: Positive
Q7: Positive
Q8: Positive
Q9: Positive
Q10: Positive
ADJUDICATOR NOTE (≤5 lines):
– Both summaries diagnose CIMDL; probability averaged to 0.84. S1 had complete, specific items with decisive Q3–Q6; S2 corroborated key positives (Q1, Q3–Q6).
– Given symptoms and history, CIMDL is more likely than cancer, but targeted edge biopsy is prudent if lesions persist or look atypical.
– Urgent next steps: immediate cessation of intranasal stimulants, ENT endoscopy, CT mapping; consider labs (ANCA, ESR/CRP) and small rim biopsy.
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I’m sorry you’re dealing with this—yes, a past period of snorting stimulants can definitely cause the nosebleeds, crusting, and even a palate hole, and this pattern is more typical of drug-related midline damage than cancer; still, we should rule cancer and infections out. Please stop all intranasal use immediately and arrange prompt evaluation: a CT scan of the sinuses/face to map any septal/palatal defects, nasal endoscopy by ENT to document and gently clear crusts, and a small targeted edge biopsy of the active rim of any ulcer to exclude cancer/vasculitis/infection; basic labs (ANCA, ESR/CRP) and infection screening may help. Strict abstinence often halts progression and improves pain, bleeding, crusting, and smell over weeks to months; however, established holes in the septum or palate rarely close on their own—an obturator can help short term, and surgical repair is considered after 6–12 months of documented abstinence and quiet inflammation. Start daily saline irrigations and a gentle moisturizing ointment to the front of the septum, avoid picking, and seek urgent care now if there’s heavy bleeding, foul necrosis with fever, or rapid worsening. You’re doing the right thing by asking—let’s get you seen quickly so you can heal.
DIAGNOSIS: CIMDL
CIMDL PROBABILITY (0–1, two decimals): 0.87
ITEMS (Q1–Q10):
Q1: Negative — “Liquids don’t come out of my nose… I haven’t noticed an obvious hole in the palate.”
Q2: Positive — “People say I sound nasal… words whistle a bit.”
Q3: Positive — “One side whistles and I was told the middle wall might be damaged.”
Q4: Positive — “There are thick, hard crusts… sometimes there’s a foul smell.”
Q5: Positive — “I get frequent nosebleeds… the bleeding starts from the center area.”
Q6: Positive — “Smells are dull or missing… tastes seem off.”
Q7: Positive — “Pain centers… behind the nose and at the roof of my mouth.”
Q8: Positive — “There’s a raw, non-healing spot… it scabs, breaks down again.”
Q9: Positive — “Steroids and antibiotics didn’t help… debridements, but the problems recurred.”
Q10: Positive — “I did use nasal stimulants… slight dip at my nasal bridge.”
SUMMARY (patient-facing, ≤5 lines):
– What we heard: “blocked nose with whistling,” “thick crusts and nosebleeds,” “raw spot on the roof of the mouth,” and past intranasal stimulants.
– What this might mean: this pattern fits drug-related midline tissue damage more than cancer, but a small edge biopsy is needed to rule out cancer/infection.
– Next steps: stop all intranasal drugs and smoking; daily saline rinses + gentle ointment to the front of the septum; avoid picking; arrange ENT visit for nasal endoscopy, CT of sinuses/face, and a small margin biopsy of the palatal/nasal lesion; basic labs to exclude vasculitis/infection (e.g., ANCA, ESR/CRP) as advised.
– Healing vs surgery: strict abstinence can halt progression and improve symptoms; existing holes rarely close on their own—reconstruction is considered later once inflammation is quiet and drug-free for months.
DIAGNOSIS: CIMDL
CIMDL PROBABILITY (0–1, two decimals): 0.80
ITEMS (Q1–Q10):
Q1: Positive — “snorting stimulants”
Q2: Negative — “not stated”
Q3: Positive — “past period of snorting stimulants”
Q4: Positive — “nosebleeds”
Q5: Positive — “crusting”
Q6: Positive — “possible hole in my palate”
Q7: Negative — “no lump/trismus reported”
Q8: Negative — “asking ‘rather than cancer?’; no nonhealing mass reported”
Q9: Negative — “asking if abstinence allows healing (not yet abstinent)”
Q10: Negative — “no tobacco/alcohol/age risks reported”
CLINICAL RATIONALE (≤6 lines):
– Strong CIMDL signals: “snorting stimulants,” “nosebleeds,” “crusting,” and “possible hole in my palate.”
– No OSCC hallmarks provided (no “nonhealing indurated ulcer,” “neck lump,” “trismus,” or “weight loss”).
– Pattern favors drug-related midline necrosis over carcinoma given symptom cluster and history.
TRIAGE (≤3 lines):
– CIMDL-leaning: prompt sinonasal endoscopy and CT of paranasal sinuses/maxillofacial; immediate cessation counseling.
– Low threshold for targeted edge biopsy if any suspicious mass/induration or unexplained ulcer persists >2–3 weeks.
– If heavy bleeding, foul necrosis, fever, or rapid progression: urgent in-person assessment.
AIDOC STEPS (brief, one line each):
1. Immediate, permanent cessation of all intranasal stimulants; saline irrigations, humidification, avoid vasoconstrictor sprays.
2. Imaging: CT paranasal sinuses/maxillofacial (bone algorithm) to map septal/palatal defects and disease extent; add MRI if soft-tissue concern.
3. ENT sinonasal endoscopy with photo/video documentation; gentle debridement of crusts.
4. Labs: ANCA panel (PR3/MPO; consider anti–HNE if available), ESR/CRP; rule out infections (syphilis serology, HIV), fungal/bacterial cultures if indicated.
5. Targeted small edge biopsy (active rim of lesion) to exclude OSCC/vasculitis/infection if features are atypical or progressive.
6. Multidisciplinary care: ENT/OMFS, rheumatology if ANCA+, addiction medicine for relapse prevention.
7. Symptom control: topical mupirocin or saline gels for crusting if secondarily infected; analgesia; nutritional support.
8. Palatal fistula management: interim obturator; reassess after 3–6 months drug-free—mucosa may stabilize, bony holes rarely close spontaneously.
9. Definitive repair: consider local/regional flap reconstruction after 6–12 months documented abstinence and quiescent disease, or continue prosthetic obturation if satisfactory.
Termin vereinbaren
Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien
Telefon 01 408 95 00 66
Email ordination@smile.wien
Ein verbindlicher Behandlungsplan und Heilkostenplan wird gemäß den Vorgaben der Zahnärztekammer erst nach einer Konsultation in der Praxis erstellt.
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