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Transcript of case presentation
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
Painful swelling at left side of the tongue.
: Sulfa Allergy (7 years ago ,She took a medication containing sulfa and she suffered from anaphylactic shock ).
: 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 .)
: Yes since 10 years ago .
: Partial Thyroidectomy 10 years ago.
Hypertension-no cardiac problems
: Digestive disorders
(carvidilol ) 25 mg - anti hypertensive drug
25 morning – 15 night .
Generalized Recession left without treatment
(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.
Irregular tooth brushing
Patient Allocation Form:
Extra oral Examination:
Ears, Nose and
TMJ are Normal,
Lips and Lymph
For the Lips :
specially at the
2x1 ulcer showing a bloody crust on the vermillion border of the lower lip .
-left mandibular lymphadenopathy : palpable, mobile, tender L.N.
-left deep cervical lymphadenopathy : palpable, mobile, tender L.N.
-submental L.N. : ------
Blood pressure :
: 80 BPM per min
(regular equal beat)
Respiratory rate :
: 37 C
Intra Oral Examination
Posterior part of the Right buccal mucosa
2x4 oval reddish brown macular pigmentation with irregular borders
while left buccal mucosa is normal
on the posterior half
of the hard palate.
of the tongue
Patient couldnot elevate her tongue after the biopsy was taken so it was difficult to examine floor of the mouth and lingual Vestibule .
6 5 2
7 6 5
Left lateral border
of the tongue shows an
exophytic mass with a non scrappable yellowish white coating
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
For Tongue Lesion:
Squamous cell Carcinoma
Long standing traumatic
ulcer superimposed with deep fungal infection (excluded due to short duration )
For the Pigmented Lesions :
Post Inflamatory Hyper Pigmentation
BT & CT
Moderately differentiated Squamous cell carcinoma
Treatment Plan :
Multidisplinary team meeting(maxillofacial surgeon,oral pathologist,Oncologist and dentist).
: resection of the mass with safety margins and left modified neck dissection.
adjuvant radiotherapy and chemotherapy.
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