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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): 0.81
MERGED ITEMS (Q1–Q10):
Q1: Positive
Q2: Negative
Q3: Positive
Q4: Positive
Q5: Positive
Q6: Positive
Q7: Positive
Q8: Positive
Q9: Positive
Q10: Negative
ADJUDICATOR NOTE (≤5 lines):
– Both summaries diagnose CIMDL; probability averaged to 0.81, with decisive positives in Q1 and Q3–Q6 supporting a stimulant-related midline destructive process.
– Proceed with strict cessation, prompt ENT endoscopy, maxillofacial CT (±MRI if soft-tissue concern), and small edge biopsies; remain alert for OSCC red flags needing urgent biopsy.
I’m sorry you’re going through this—it’s scary, but your symptoms can indeed be explained by prior intranasal stimulant use, which commonly causes nosebleeds, crusting, and even a palate perforation; cancer is less likely with this pattern, though it must be ruled out. The most useful tests are an in-person nasal endoscopy by an ENT, a CT scan of the sinuses/maxillofacial bones (add MRI if a soft‑tissue mass is suspected), and a small edge biopsy from the rim of the palate or intranasal lesion to exclude cancer/infection; clinicians may add targeted labs (e.g., for autoimmune mimics) based on findings. Complete abstinence is critical: inflammation often settles over weeks, small raw areas may heal, and progression usually stops; established holes rarely close on their own, so after several months of quiescence you may use an obturator and, if needed, consider delayed surgical repair. Please arrange evaluation promptly; seek urgent care now for heavy bleeding, a rapidly enlarging defect, severe pain/swelling, or fevers. In the meantime, avoid all intranasal drugs and smoke exposure, use gentle saline rinses and humidification, and avoid nose picking.
DIAGNOSIS: CIMDL
CIMDL PROBABILITY (0–1, two decimals): 0.84
ITEMS (Q1–Q10):
Q1: Negative — “Liquids don’t come out of my nose.”
Q2: Negative — “My voice doesn’t sound especially nasal.”
Q3: Positive — “My nose feels blocked most days… one side whistles.”
Q4: Negative — “I don’t notice heavy crusting.”
Q5: Positive — “I get frequent nosebleeds.”
Q6: Positive — “Smells are dull or missing.”
Q7: Positive — “Pain centers… behind the nose and at the roof of my mouth.”
Q8: Positive — “A raw, non-healing spot… seems to widen slowly.”
Q9: Negative — “I haven’t had strong treatments before.”
Q10: Negative — “I don’t have fevers…”
SUMMARY (patient-facing, ≤5 lines):
– What we heard: “one side whistles,” and “a raw, non-healing spot at the roof of my mouth.”
– What this might mean: The pattern fits stimulant-related midline destructive lesions more than a typical oral cancer, though cancer and a few other conditions still must be ruled out.
– Next steps: Stop all intranasal drugs and smoke exposure; continue gentle saline rinses and humidification. Arrange prompt ENT/Head & Neck visit for nasal endoscopy and full oral exam; get maxillofacial CT (±MRI if soft tissue spread suspected); have small edge biopsies of the palate/nasal lesion to confirm the cause. With strict abstinence, inflammation can settle; small defects may scar over, but larger holes often need later repair or an obturator once the process has been quiet for months.
DIAGNOSIS: CIMDL
CIMDL PROBABILITY (0–1, two decimals): 0.78
ITEMS (Q1–Q10):
Q1: Positive — “past period of snorting stimulants”
Q2: Negative — “past period” (implies not current)
Q3: Positive — “nosebleeds”
Q4: Positive — “crusting”
Q5: Positive — “possible hole in my palate”
Q6: Negative — “no mention of septum/midline”
Q7: Negative — “no painful lump/indurated ulcer/trismus mentioned”
Q8: Negative — “no non‑healing oral ulcer or enlarging mass described”
Q9: Positive — “nosebleeds, crusting” (chronic sinonasal symptoms)
Q10: Negative — “no neck nodes/weight loss reported”
CLINICAL RATIONALE (≤6 lines):
– Decisive CIMDL items: “snorting stimulants,” “nosebleeds,” “crusting,” “possible hole in my palate.”
– No OSCC‑leaning red flags provided (no “non‑healing ulcer,” “growing mass,” or “neck lump”).
– Pattern favors drug‑related midline destructive process over primary oral SCC given the specific sinonasal clues.
TRIAGE (≤3 lines):
– CIMDL‑leaning: arrange sinonasal endoscopy, strict cessation counseling, and targeted imaging.
– If any OSCC red flags emerge (non‑healing ulcer/mass, induration, nodes) → urgent in‑person exam with biopsy and imaging.
AIDOC STEPS (brief, one line each):
1. Immediate safety: assess severity of epistaxis; advise saline sprays/avoid nose picking; urgent care if heavy bleeding.
2. Substance history and cessation: confirm last use; commit to complete abstinence; support/monitor adherence.
3. Nasal endoscopy (ENT): document septum, turbinates, posterior palate; photo/video for comparison.
4. Imaging: CT maxillofacial/sinuses (bone algorithm) to map any septal/palatal defects and bony erosion; add contrast/MRI if soft‑tissue mass suspected.
5. Targeted biopsy: small edge biopsy of the palatal defect (viable margin) ± intranasal lesion to exclude malignancy/infection; send for histology and cultures as indicated.
6. Oral/nasal care: humidification, saline irrigations, gentle crust debridement; avoid intranasal irritants; dental review for obturation needs.
7. Rule‑in/out other mimics as appropriate (autoimmune/vasculitic or infectious workup guided by exam/biopsy findings).
8. Follow‑up: re‑evaluate healing at 6–8 weeks post‑cessation with repeat endoscopy; adjust care based on symptom and imaging trajectory.
9. Reconstruction: if perforation persists/symptomatic after disease quiescence, consider prosthetic obturator first; delayed surgical repair only once stability is confirmed.
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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