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**“Questionnaire for Sigmund Freud’s Paper CIMDL.
**Formbricks data entry: https://forms.medlibre.ai/s/cm8ncc7pv000fb3012cpgbht9
TEASER PROMPT: https://cloud.medlibre.ai/s/Z3ygJeSAJiJtfMK
MAIN PROMPT: https://cloud.medlibre.ai/s/mSg2DZpiPBTcFCg
CONSENSUS PROMPT: https://cloud.medlibre.ai/s/8PdEe9MTEbyLYNW
Excel Sheet with 100 questions: https://consultation.medlibre.ai/own
PROJECT INFO: https://medlibre.craft.me/tVk8OQB3c2tdHw
©2025 Michael Truppe, MD“
CONSENSUS DIAGNOSIS: CIMDL
CONSENSUS CIMDL PROBABILITY (0–1, two decimals): 0.87
MERGED ITEMS (Q1–Q10):
Q1: Positive
Q2: Negative
Q3: Positive
Q4: Positive
Q5: Positive
Q6: Positive
Q7: Positive
Q8: Positive
Q9: Negative
Q10: Negative
ADJUDICATOR NOTE (≤5 lines):
– Both summaries diagnose CIMDL; probability averaged. Summary A had complete items with decisive Q3/Q5/Q6 and OSCC-relevant Q7/Q8; Summary B reinforced CIMDL with Q1/Q4–Q6.
– Proceed to rule out malignancy/infection with nasal endoscopy, CT maxillofacial/sinuses, and an edge biopsy; begin strict abstinence and local care now; seek urgent care for heavy bleeding or rapid change.
Your past period of snorting stimulants could indeed explain the nosebleeds, crusting, and a possible palate hole—this pattern is classic for drug-related midline tissue injury—yet it’s important to promptly exclude infection or cancer. At a distance, we can start with clear photos/video of the palate and nostrils, symptom timelines, and basic labs (e.g., ESR/CRP, ANCA), but confirmation typically requires an in-person nasal endoscopy, a CT scan of the sinuses/maxillofacial area to map bone loss, and a small edge biopsy of the lesion to rule out cancer—ideally within 1–2 weeks, sooner if bleeding is heavy or the area is enlarging. Please stop all intranasal drugs immediately, use saline rinses/humidification and a bland ointment, and avoid decongestant sprays; many defects stabilize with abstinence, but larger holes rarely close on their own—an obturator can restore function now, with surgical reconstruction considered after several months of proven abstinence and stability or earlier if complications demand it.
DIAGNOSIS: CIMDL
CIMDL PROBABILITY (0–1, two decimals): 0.88
ITEMS (Q1–Q10):
Q1: Negative — “Liquids don’t come out of my nose.”
Q2: Negative — “My voice doesn’t sound especially nasal.”
Q3: Positive — “One side whistles…middle wall might be damaged.”
Q4: Negative — “I don’t notice heavy crusting.”
Q5: Positive — “I get frequent nosebleeds…”
Q6: Positive — “Smells are dull or missing.”
Q7: Positive — “Pain…behind the nose and at the roof of my mouth.”
Q8: Positive — “raw, non-healing spot…seems to widen slowly.”
Q9: Negative — “Have you previously been diagnosed…steroids for ‘vasculitis’…?”
Q10: Negative — “I don’t have fevers, joint pains, or chest problems.”
SUMMARY (patient-facing, ≤5 lines):
– What we heard: “frequent nosebleeds,” “one side whistles,” and a “raw, non-healing spot” at the roof of the mouth/nose with reduced smell.
– What this might mean: more consistent with drug-related midline tissue injury than oral cancer, but infection or cancer must still be ruled out.
– Next steps: arrange ENT/OMFS visit for nasal endoscopy and oral exam; obtain CT maxillofacial/sinuses; small edge biopsy of the palate/nasal lesion; basic labs (ANCA, ESR/CRP) to exclude vasculitis.
– Care: strict abstinence from intranasal drugs; saline rinses/humidification and gentle ointment; defects often stabilize but larger holes rarely close—an obturator can help now, with reconstruction considered after several months of confirmed abstinence and stability.
DIAGNOSIS: CIMDL
CIMDL PROBABILITY (0–1, two decimals): 0.86
ITEMS (Q1–Q10):
Q1: Positive — “past period of snorting stimulants”
Q2: Negative — “not stated”
Q3: Negative — “not stated”
Q4: Positive — “crusting”
Q5: Positive — “nosebleeds”
Q6: Positive — “possible hole in my palate”
Q7: Negative — “not stated”
Q8: Negative — “not stated”
Q9: Negative — “not stated”
Q10: Negative — “not stated”
CLINICAL RATIONALE (≤6 lines):
– CIMDL-leaning because of stimulant snorting history and midline sinonasal/oral features: “snorting stimulants,” “nosebleeds,” “crusting,” “possible hole in my palate.”
– No reported OSCC-red flags (no “nonhealing mass/ulcer,” no “neck lump,” no “weight loss”).
– Pattern fits drug-related midline destruction more than primary oral cancer based on the symptoms provided.
TRIAGE (≤3 lines):
– Arrange ENT/OMFS evaluation with sinonasal endoscopy and targeted imaging within 1–2 weeks.
– Immediate abstinence counseling; start local nasal/oral care.
– Urgent in-person visit sooner if heavy bleeding, rapidly enlarging lesion, or new neck lump.
AIDOC STEPS (brief, one line each):
1. Confirm timeline/extent of intranasal stimulant use; strict immediate abstinence.
2. High-quality photos/video of palate and nostrils for tele-triage; document bleeding/crusting frequency.
3. In-person flexible nasal endoscopy to map septum, turbinates, nasopharynx, and palatal margins.
4. CT paranasal sinuses/maxillofacial (thin-slice) to assess bony loss; add MRI if any soft-tissue mass is suspected.
5. Targeted incisional biopsy at the edge of the palatal defect and any indurated/ulcerated areas to exclude carcinoma.
6. Basic labs and focused screens as indicated locally (e.g., vasculitis/infectious workup) to rule mimics.
7. Local care: saline irrigations, humidification, bland emollient to reduce crusting; avoid vasoconstrictive sprays; dental review.
8. Review results in 2–3 weeks; if CIMDL confirmed and stable, continue conservative care; if malignant features, expedite oncology pathway.
9. Reconstruction plan: obturator versus surgical closure considered only after sustained abstinence and disease quiescence; earlier if complications demand.
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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