${VPS_HEADER}
**Summary of Patient’s Case and Information:**
**Name:** Sigmund Freud
**DOB:** June 5, 1856
**Age:** 67 years old (as of October 1, 1923)
**Relevant Medical History:**
– Heavy smoking of cigars since age 24
– Cardiac incident and arrhythmia in 1889
– Painful swelling in the palate in 1917
– Multiple operations for recurrent lesions on the palate and jaw from April to November 1923
– Recent identification of a malignant recurrence by Prof. Pichler
**Symptoms:**
– Presence of red spots on the gums or tongue
– Moderate sensory changes in the mouth
– Slight difficulty or pain when swallowing
**Upcoming Procedure:** A planned surgery by Dr. Hans Pichler on the palate.
—
### **Step-by-Step Evaluation and Recommendations**
**1. Initial Analysis:**
Given the patient’s current condition and history of recurrent malignant lesions in the oral cavity, there are three potential diagnoses to consider:
**A. Squamous Cell Carcinoma (SCC) of the Palate:**
– **Supporting Information:** The presence of persistent lesions, a history of smoking, and recurrent malignant findings in previous biopsies.
– **Treatment Options:**
– **Surgical Resection:** Partial or total maxillectomy to remove the affected tissue.
– *Advantages:* Potential for complete removal of the malignant tissue.
– *Disadvantages:* Risk of significant functional impairment, difficulty in prosthetic rehabilitation, and potential for recurrence.
– **Radiotherapy:** As an adjunct to surgery or as a primary treatment if the lesion is not resectable.
– *Advantages:* Non-invasive, can target residual malignant cells.
– *Disadvantages:* Potential for mucositis, oropharyngeal discomfort, and long-term effects on oral tissues.
**B. Verrucous Carcinoma:**
– **Supporting Information:** Verrucous carcinoma is a variant of SCC that is less aggressive but can be locally invasive.
– **Treatment Options:**
– **Surgical Excision:** Complete removal of the lesion with clear margins.
– *Advantages:* Lower risk of metastasis compared to SCC.
– *Disadvantages:* Similar to SCC, there is a need for extensive surgery which may impair oral functions.
**C. Chronic Traumatic Ulcer:**
– **Supporting Information:** Chronic irritation due to smoking, poorly fitting dental appliances, or habitual cheek biting.
– **Treatment Options:**
– **Conservative Management:** Removal of the irritant, smoking cessation, and use of protective appliances.
– *Advantages:* Non-invasive and preserves tissue.
– *Disadvantages:* If underlying malignancy is present, this approach would be insufficient and delay appropriate treatment.
**2. Treatment Recommendation:**
**Diagnosis:** Based on the patient’s history and the recurrent nature of the lesions, **Squamous Cell Carcinoma (SCC)** is the most likely diagnosis.
**Recommended Treatment Approach:**
Given the recurrent and malignant nature of the lesion, I would recommend **surgical resection** followed by **adjuvant radiotherapy** if necessary.
**Detailed Surgical Plan:**
**A. Partial Maxillectomy and Partial Mandibulectomy:**
– **Rationale:** To ensure complete removal of the malignant tissue, and considering previous incomplete resections, this approach aims to achieve clear margins.
– **Procedure Steps:**
1. **Preoperative Preparation:** Rigorous oral hygiene, assessment of cardiac status, and smoking cessation.
2. **First Stage:** Ligation of the right external carotid artery to minimize blood loss.
3. **Second Stage:** Full resection of the right maxilla from the canine to the tuberosity, including part of the pterygoid muscle and mandibular sections. Reconstruction with skin grafts.
4. **Postoperative Care:** Placement of an obturator prosthesis for functional rehabilitation, regular follow-up for adjustments and monitoring for recurrence.
– **Advantages:** Comprehensive removal of cancerous tissue, potential for long-term control of malignancy.
– **Disadvantages:** High risk of functional impairment (speaking, chewing, swallowing), need for extensive rehabilitation, and potential for significant morbidity and impact on quality of life.
**Radiotherapy:**
– **Postoperative Radiotherapy:** Targeting the surgical bed to eliminate residual malignant cells.
– *Advantages:* Enhances local control of the disease.
– *Disadvantages:* Risk of radiation-induced mucositis, xerostomia, and long-term tissue fibrosis.
**3. Patient’s Questions and Concerns:**
**Will I be completely cured?**
– **Answer:** While the goal of the treatment is to achieve complete removal of the malignant tissue and prevent recurrence, there is no absolute guarantee of total cure due to the aggressive and recurrent nature of SCC. Continuous follow-up and monitoring are essential.
**Can I continue to smoke cigars?**
– **Answer:** Smoking cessation is strongly recommended. Continued smoking can significantly increase the risk of recurrence and complicate healing. It is crucial to stop smoking to improve the chances of successful treatment and recovery.
**Will I be able to chew solid food again?**
– **Answer:** Post-surgery, you may experience difficulties with chewing, especially initially. The obturator prosthesis will help in restoring some function, but it may not be as effective as natural dentition. Adaptive techniques and perhaps dietary modifications may be necessary.
—
**Conclusion:**
**Top Diagnosis:** Squamous Cell Carcinoma (SCC) of the Palate
**Recommended Treatment:** Surgical resection (partial maxillectomy and mandibulectomy) followed by adjuvant radiotherapy.
**Secondary Options:** Consideration of conservative management for less aggressive or non-malignant lesions, but given the history and biopsy results, this is less likely to be sufficient.
**Signature:**
Prof. Rolf EWERS, AI generated text
### [Termin vereinbaren](https://calendly.com/smile-wien/implantat-beratung-ai)
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.
© 2024 Eurodoc Telemedizin ForschungsgesellschaftmbH
