In late 1917 I had a painful swelling at the soft palate, it soon receeded after I lit up a cigar. It is now 1923 and I have a leukoplastic growth on my jaw and palate. Just now, on April 7 1923 Felix Deutsch does not agree with epithelioma and talks about a “bad leukoplakia”. I will consult a rhinologist to excise the growth. Nobody mentioned the dread word cancer although they recommend that I quit the cigars. Nevertheless before leaving for the cosmetic procedure I ask for the advice of a maxillofacial surgeon.

Dear Patient,

I am Prof. R. E., an oral and maxillofacial surgeon in Vienna. I have carefully reviewed your medical history as documented in Pichler’s notes and relevant literature regarding your current condition.

Your initial experience of a painful swelling at the soft palate in late 1917, which resolved upon smoking cigars, is consistent with a psychogenic lesion or transient inflammation. However, the recent development of a leukoplastic growth on your jaw and palate raises concerns for a potentially more serious condition.

Leukoplakia is a white patch or plaque that can occur in various areas within the oral cavity. While most cases are benign, some may progress to malignant transformation, particularly when associated with risk factors such as tobacco use. In your case, your extensive smoking history (reportedly more than 20 cigars per day) increases the likelihood of a malignant lesion, such as squamous cell carcinoma.

Felix Deutsch’s assessment of “bad leukoplakia” may suggest a more aggressive form of this condition. However, it is essential to establish an accurate diagnosis before proceeding with any treatment. A rhinologist’s consultation for excision of the growth is a reasonable initial step. Nevertheless, I strongly advise you to seek the advice of a maxillofacial surgeon prior to undergoing any cosmetic procedure.

As a precautionary measure, I recommend that you consider quitting smoking altogether to minimize potential complications and improve your overall health. Alternative treatments for nicotine addiction include nicotine replacement therapy, counseling, or medications such as bupropion or varenicline.

If the diagnosis is cancerous, various treatment options are available depending on the stage and location of the tumor. These may include surgery, radiation therapy, chemotherapy, or a combination of these modalities. Early detection and intervention significantly improve the chances for successful treatment and recovery.

I urge you to prioritize your health and seek professional advice promptly. Please do not hesitate to contact me if you have any questions or concerns regarding your condition.

Sincerely,
Prof. R. E.

2024-01-30 20:50 Telekonsultation

Dear Esteemed Patient Sigmund Freud,

I have carefully reviewed your medical history and recent developments regarding the growth on your jaw and palate. While Felix Deutsch’s diagnosis of epithelioma may not be definitive, it is essential to consider all possibilities, including cancer. Given your extensive smoking history and the fact that this growth has persisted despite quitting cigars once before, I strongly advise you to seek a definitive diagnosis from an experienced oral pathologist or oncologist.

As a precautionary measure, I would also recommend that you cease smoking immediately, as tobacco use is a significant risk factor for oral cancer. This may be challenging given your history of heavy cigar consumption, but it is crucial for your overall health and well-being.

Regarding the cosmetic procedure you mentioned, I would advise against undergoing this without first obtaining a definitive diagnosis. The growth’s nature could significantly impact the approach to both the diagnostic and therapeutic processes. If cancer is confirmed, more extensive treatment may be necessary, which could compromise the results of any cosmetic procedure.

In terms of alternative treatments for oral lesions, there are various options depending on the diagnosis. For benign conditions like leukoplakia, topical agents such as retinoids or chemotherapeutic agents can be used to promote healing and reduce symptoms. For malignant conditions, surgical excision, radiation therapy, chemotherapy, or a combination of these modalities may be required.

If you decide to proceed with the rhinologist’s consultation for the growth excision, I would recommend that you also consult an oral pathologist or oncologist beforehand to discuss your options and ensure that all necessary diagnostic tests are performed. This will help establish a definitive diagnosis and guide the most appropriate treatment plan moving forward.

I wish you the best of luck in this process and am here to answer any questions or concerns you may have as you navigate this journey towards better health.

Sincerely,

Hans Pichler (1877 – 1949)
Head of the Maxillofacial Surgery Department
First Surgical University Clinic

Termin vereinbaren

Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien

Telefon 01 408 95 00 66
Email ordination@smile.wien

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