If surgery is indeed unavoidable, what exactly would the procedure involve? What parts of my mouth would be affected?

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TEASER Summary Evaluation:

• Rating: 2

• Evidence supporting CIMDL: The summary mentions potential symptoms like visible deformity, which could align with facial deformities seen in CIMDL. However, it lacks specificity regarding nasal symptoms or palate problems directly associated with CIMDL.

• Missing/conflicting information: There is no mention of progressive nasal/oral/facial damage, which is central to CIMDL. The summary focuses more on historical maxillofacial issues, such as fractures and tumors, without specific reference to cocaine use or associated symptoms like nasal blockage, bleeding, or discharge.

MAIN Summary Evaluation:

• Rating: 1

• Evidence supporting CIMDL: There is no direct evidence supporting CIMDL in this summary. The primary diagnosis is maxillary carcinoma, with a focus on cancer-related symptoms and interventions.

• Missing/conflicting information: The summary does not mention any of the key symptoms or secondary issues related to CIMDL, such as nasal symptoms, palate problems, or the role of cocaine use. Instead, it centers on cancer diagnosis and treatment, which are not aligned with CIMDL.

1. Symptoms Analysis:
   To provide a detailed answer, it would be imperative to know the precise condition requiring surgery. Common maxillofacial issues in the 1930s include jaw fractures, infections such as osteomyelitis, or tumors. Typical symptoms leading to surgery might include persistent pain, swelling, difficulty chewing, or visible deformity.

2. Primary Diagnosis:
   One potential condition necessitating surgery could be a mandibular fracture, often resulting from trauma. Surgical intervention may be required if the fracture is displaced or unstable. The aim would be to realign and stabilize the bone for proper healing.

3. Differential Diagnosis:

– Osteomyelitis: An infection of the jawbone, characterized by fever, swelling, and pain. Surgical debridement may be required if antibiotics fail.
– Dental Abscess: Could necessitate tooth extraction and drainage if antibiotics are insufficient.
– Benign Tumors: Conditions such as ameloblastoma may require surgical removal due to excessive growth and facial distortion.
– Malocclusion due to developmental abnormalities: Surgery might involve osteotomy to correct the alignment.

Surgical Procedure:
The procedure might involve exposure of the affected jaw region via intraoral or extraoral incisions. For fractures, reduction and fixation using wires or plates—an emerging technique in the 1930s—would be employed. Soft tissues would also be managed to ensure proper closure and healing.

Affected regions could include the alveolar ridge, mandible, or maxilla, depending on the specific pathology necessitating surgical intervention.

PICHLER TEASER002/040125

Primary Diagnosis:

Maxillary Carcinoma (with Mandibular Involvement)

Explanation:

• History of Tobacco Use: Prolonged smoking history with significant exposure to carcinogens.
• Clinical Signs: Leukoplakia-like lesions, progressive ulceration, and eventual development of a malignant tumor.
• Surgical Interventions: Multiple resections targeting the right maxilla and mandible, indicative of aggressive malignant growth.
• Histopathological Findings: Recurrence confirmed by biopsy as malignant, reinforcing diagnosis of carcinoma.

Differential Diagnoses:

1. Osteosarcoma:
   • Justification: Bone involvement and aggressive nature.
   • Comparison: Less common in the maxilla/mandible in this age group.
2. Lymphoma:
   • Justification: Lymph node involvement.
   • Comparison: Typically presents differently, often involves systemic symptoms.
3. Infectious Granulomatous Disease:
   • Justification: Chronic ulceration.
   • Comparison: Lack of consistent systemic infection signs or response to antimicrobials.

Surgical Procedure Involvement:

• Partial Maxillectomy: Removal of portions of the right maxilla from the canine to the tuberosity.
• Partial Mandibulectomy: Resection of the lingual cortex of the right mandible and associated teeth.
• Submandibular Gland and Lymph Nodes: These were resected during the first stage to manage metastatic risk.
• Pterygoid and Soft Palate: Further resection involved these areas due to recurrence.
• Reconstruction: Use of skin grafts and obturators to manage resultant defects and maintain function.

Affected Areas:

• Maxilla and Mandible: Right posterior regions.
• Soft Palate and Cheek: Involved in the caustic resection procedures and subsequent structural compromise.

Signature:
MAIN002/040125

Termin vereinbaren

Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien

Telefon 01 408 95 00 66
Email ordination@smile.wien

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