Professor, you mentioned examining the lesion closely. What exactly will you be looking for during the examination?

This is a testimonial placeholder text.

This is a testimonial placeholder text

Ratings:

• TEASER Summary: 4
• MAIN Summary: 1

Feedback:

• TEASER Summary:
  • The TEASER Summary shows moderate alignment with CIMDL indicators. It highlights key symptoms like nasal septum perforation, crusting, and tissue necrosis, which are consistent with cocaine-induced damage. The mention of ulcerative perforation of the nasal septum strongly suggests CIMDL. However, the summary also presents alternative diagnoses like syphilitic gumma and tuberculosis, which could account for similar symptoms, leaving room for doubt. Additional evidence of cocaine use or confirmation of systemic symptoms associated with CIMDL would strengthen the diagnosis.
• MAIN Summary:
  • The MAIN Summary does not align with CIMDL indicators. It focuses on an oral squamous cell carcinoma diagnosis, supported by evidence of leukoplakia, trismus, and submandibular lymph node involvement, which are not typical of CIMDL. The history of nicotine abuse aligns with oral carcinoma rather than CIMDL. There is no mention of nasal or midline destructive lesions, which are crucial for a CIMDL diagnosis. Thus, the evidence supports a different primary condition.

1. Symptoms Analysis:
   During the examination of a lesion, particularly in the nasal fossa, I will be observing for key symptoms associated with ulceration. Specifically, I am interested in identifying the presence of tissue necrosis, crusting, and any perforation in the septum. These could indicate ulceration, which, according to Owens, is frequently associated with cocaine use. Additionally, I will evaluate the lesion’s appearance, size, and any discharge that may provide insight into its nature.

2. Primary Diagnosis:
   Given these observations, the primary diagnosis could be ulcerative perforation of the nasal septum. This condition is often linked to cocaine addiction, which causes ischemic necrosis of the septal cartilage. The presence of a perforated septum with crusting and necrosis strongly suggests this diagnosis.

3. Differential Diagnosis:
   Other possible diagnoses might include syphilitic gumma, which can cause similar necrotic lesions but would typically be accompanied by systemic signs of syphilis and positive serological tests. Tuberculosis could also manifest with nasal lesions, but this would generally present with more systemic respiratory symptoms. Lastly, a malignancy such as squamous cell carcinoma should be considered, especially if the lesion has irregular borders and rapid growth, although it typically presents later in life.

Proper differentiation relies on thorough clinical evaluation and, if necessary, histological analysis, keeping in mind the limited diagnostic tools available in the 1930s.

PICHLER TEASER002/040125

Primary Diagnosis:

• Diagnosis: Oral Squamous Cell Carcinoma (OSCC)
• Explanation:
  • The lesion’s description as a „leukoplastic growth on the jaw and palate“ aligns with OSCC, often presenting as leukoplakia which can be a precancerous condition.
  • The aggressive recurrence and need for multiple surgeries suggest a malignant process, characteristic of OSCC.
  • Clinical features such as the ulceration, trismus, and palpable submandibular lymph node are consistent with invasive growth, common in OSCC.
  • The significant nicotine abuse history (20 cigars/day) is a known risk factor for OSCC.

Differential Diagnoses:

1. Leukoplakia with Dysplasia:
   • Justification: Leukoplakia can progress to dysplasia, which might explain the initial lesion. However, the rapid progression and recurrence make this less likely compared to OSCC.
2. Chronic Traumatic Ulcer:
   • Justification: Could account for ulcerative lesion; however, would not account for submandibular node involvement or persistent recurrence post-surgery.
3. Verrucous Carcinoma:
   • Justification: A variant of OSCC with less aggressive behavior. The recurrent nature and nodal involvement seen in Freud’s case are more typical of conventional OSCC.
4. Osteoradionecrosis:
   • Justification: History of radiotherapy could lead to necrosis, but the timeline and lesion characteristics strongly suggest malignancy.

Conclusion:
OSCC remains the most plausible diagnosis given the lesion’s behavior, recurrence, and the patient’s smoking history. The differential diagnoses lack alignment with the aggressive and recurrent nature of the lesion, making OSCC the most consistent diagnosis.

Signature:
MAIN002/040125

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.

© 2024 Eurodoc Telemedizin ForschungsgesellschaftmbH