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case presentation

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by

Farida Reyad

on 7 May 2014

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Transcript of case presentation

Name:
Sawsan Abbas
Sex:
Female
Age:
56
Occupation:
House wife
Marital Status:
Married
Address:
Abu Soliman


History of present illness:
The condition started since last February with continuous throbbing pain aggrevated by salt, sour and hot foods and relieved by analgesics. After wards the condition became accompanied by continuous headache and pain at left side of face and neck

Chief Complaint:
Painful swelling at left side of the tongue.


Demographic data:
Allergy
: Sulfa Allergy (7 years ago ,She took a medication containing sulfa and she suffered from anaphylactic shock ).
Diabetes
: Type 2 DM since 16 years .(*diabetes started 16 years ago – being treated with oral hypoglycemic drugs but 6 years ago Insulin was added to her treatment .)
Hypertension
: Yes since 10 years ago .
Previous Surgeries
: Partial Thyroidectomy 10 years ago.


Systemic Problems:
CardioVascular System:
Hypertension-no cardiac problems
Gastrointestinal System
: Digestive disorders
Musculoskeletal System
: Arthalgia
Endocrine
:Hemithyroidectomy


Drug History:

-
Carvipress
(carvidilol ) 25 mg - anti hypertensive drug

-
Insulin
25 morning – 15 night .

-
Cidophage retard

-
Eltroxin
150 mg

-
Vitamix


Periodontal Problems:
Generalized Recession left without treatment

Previous
Extractions
(due to caries ) with
no history of complications
, the last of them was 2 years ago (in upper right quadrant).

No history of restorative or orthodontic treatment.
Habits:
Mouth Breathing
Irregular tooth brushing
Patient Allocation Form:
Medical History
Dental History:
Case Presentation

Extra oral Examination:
Skin, Sclera,Eyes,
Ears, Nose and
TMJ are Normal,

Examination of
Lips and Lymph
Nodes revealed:
For the Lips :
Dry Lips
specially at the
commisures.
at
Vermillion Border:
2x1 ulcer showing a bloody crust on the vermillion border of the lower lip .
LYMPH NODES
EXAMINATION
-left mandibular lymphadenopathy : palpable, mobile, tender L.N.

-left deep cervical lymphadenopathy : palpable, mobile, tender L.N.

-submental L.N. : ------

Vital signs
Blood pressure :
130/80mmhg.
Pulse rate
: 80 BPM per min
(regular equal beat)
Respiratory rate :
12 cycle/min.
Temperature
: 37 C

Intra Oral Examination
Labial Mucosa
Normal
Buccal Mucosa
Posterior part of the Right buccal mucosa
shows a
2x4 oval reddish brown macular pigmentation with irregular borders
while left buccal mucosa is normal
Palate:
Diffuse brown
melanotic pigmentation
on the posterior half
of the hard palate.

Tongue:
Dorsal surface
of the tongue
shows
yellowish
increased
tongue coat.

Patient couldnot elevate her tongue after the biopsy was taken so it was difficult to examine floor of the mouth and lingual Vestibule .


Teeth Examination:
7
Decayed
Missing
6 5 2
4 6
6 7
7 6 5
1 1
Left lateral border
of the tongue shows an
exophytic mass with a non scrappable yellowish white coating
Lesion Description:
Single tender exophytic mass about 6*4 cm with granular rough surface and a non scrappable yellowish white coating,had a central horizontal cleft in the middle of the mass opposite to the remaining teeth, the base is indurated on palpation
Differential Diagnosis:
For Tongue Lesion:
Squamous cell Carcinoma
Adeno Carcinoma
Sarcoma
Lymphangioma
Long standing traumatic
ulcer superimposed with deep fungal infection (excluded due to short duration )

For the Pigmented Lesions :
Post Inflamatory Hyper Pigmentation
Physiologic Pigmentation

Investigations
Incisional Biopsy
Radiograph:
lab Investigations
FBST
BT & CT
CBC
Final Diagnosis
Moderately differentiated Squamous cell carcinoma
Treatment Plan :
Preoperative:
Multidisplinary team meeting(maxillofacial surgeon,oral pathologist,Oncologist and dentist).

Operative procedure
: resection of the mass with safety margins and left modified neck dissection.

Postoperative:
adjuvant radiotherapy and chemotherapy.


Fractured
Post Contrast CT examination of the neck
The aim of the study was a determination of the levels of nitric oxide (NO) and its biological markers such as malonyldialdehyde (MDA) and nitrotyrosine in the serum of patients with squamous cell carcinoma (SCC) of the oral cavity
Higher concentrations of NO in blood serum were determined in patients with stage IV of the disease before treatment in comparison to the control group and patients with stages II and III of the disease. Higher concentrations of MDA and nitrotyrosine were determined in the serum of patients in all stages of the disease
After treatment, lower concentrations were found than those before treatment .
Levels of biological markers of nitric oxide in serum of patients with squamous cell carcinoma of the oral cavity
Full transcript