what is the recommended tratment for my palatinal ulcerous lesion?

Dear Mr. Freud,

Thank you for your inquiry regarding the recommended treatment for your palatal ulcerous lesion. Based on the information provided and the historical context of your case, I will outline the step-by-step treatment that was proposed and undertaken at the time.

Initial Assessment and Diagnosis:
Upon your initial examination, it was noted that you had a crater-shaped ulcer on the posterior aspect of the right maxillary tuberosity, a palpable submandibular node, and trismus, which is a restriction in the opening of the mouth. These findings are indicative of a significant underlying pathology, likely of a malignant nature.

Radiotherapy:
As advised by Dr. Hajek, you underwent radiotherapy under the care of Guido Holzknecht. This treatment was aimed at reducing the size of the tumor and controlling its local spread. Radiotherapy in the early 20th century was a relatively new modality and was used with the hope of achieving tumor regression.

Radium Capsule Treatments:
In conjunction with radiotherapy, one of Dr. Hajek’s assistants, Feuchtinger, administered a series of treatments using radium capsules. Radium was used for its radioactive properties, which were believed to have a therapeutic effect on cancerous lesions.

Surgical Intervention:
Despite these treatments, your condition continued to deteriorate, leading to a consultation with Professor Hans Pichler. Professor Pichler recommended a radical excision of the tumor to remove the cancerous tissue. This surgical procedure would involve the careful removal of the affected tissues in the palate and surrounding areas to ensure complete excision of the lesion.

Palatal Obturation:
Following the excision, there would be a resulting defect in the palate. To address this, Professor Pichler advised the use of a removable prosthesis, known as an obturator, to close the defect and restore function. This obturator would allow you to speak and eat more comfortably and would also improve your quality of life.

Prosthesis Modification:
The last obturator made for you by Professor Pichler in 1935 was designed to be more comfortable and easier to insert. According to his notes, he modified this denture by removing the palatal cusps of the upper molars, which is a customization to fit your specific anatomical needs.

Ongoing Care and Monitoring:
After the surgical and prosthetic interventions, regular follow-up would be necessary to monitor the healing process, the fit and function of the prosthesis, and to check for any signs of recurrence or complications.

It is important to note that the treatment modalities available during the early 20th century were limited compared to today’s standards. The approach taken by your medical team was based on the best knowledge and technology available at the time.

Please feel free to reach out if you have any further questions or concerns regarding your treatment.

Sincerely,

Prof. R. E.
University Vienna
(AI generated)

2024-02-04 16:48 Telekonsultation

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

Dear Patient,

Thank you for your inquiry regarding the recommended treatment for your palatal ulcerous lesion. Based on the information provided and utilizing the medical knowledge available up to the year 2024, I will outline a step-by-step approach to deduce a differential diagnosis and determine the most appropriate treatment advice.

Step 1: Broad Differential Diagnosis

1. Malignant Neoplasm: Given the history of a crater-shaped ulcer, this could be indicative of an oral cancer, such as squamous cell carcinoma.
2. Benign Neoplasm: Less likely, but a benign tumor could present with ulceration if it becomes secondarily infected or traumatized.
3. Infectious Disease: An ulcer could be a manifestation of a bacterial, viral, or fungal infection, particularly in immunocompromised individuals.

Step 2: Reference Patient Information

The presence of a palpable submandibular node and trismus, along with the deterioration of the condition despite previous treatments, increases the likelihood of a malignant process.

Step 3: Narrowed Differential Diagnosis

1. Squamous Cell Carcinoma: The most common oral malignancy, often presenting with ulceration and regional lymphadenopathy.
2. Other Oral Cancers: Less common malignancies such as adenocarcinoma or sarcoma.
3. Osteonecrosis: Although less likely, osteonecrosis can present with ulceration, especially in the context of previous radiotherapy.

Step 4: Further Refinement

The history of radiotherapy and radium capsule treatments, along with the clinical presentation, makes a malignant neoplasm the most likely diagnosis. Osteonecrosis is also a consideration due to the history of radiation but is less likely given the clinical presentation.

Step 5: Treatment Advice

1. Radical Surgical Excision: The primary recommendation is the surgical removal of the tumor with clear margins to ensure complete excision of the malignant tissue.
2. Reconstruction and Prosthesis: Following excision, reconstruction of the defect and obturation with a removable prosthesis is advised to restore function and aesthetics.
3. Adjuvant Therapy: Depending on the final pathology report, adjuvant therapy such as further radiotherapy or chemotherapy may be indicated to address any residual disease or to reduce the risk of recurrence.

In conclusion, the most likely diagnosis for your palatal ulcerous lesion is a malignant neoplasm, and the recommended treatment is radical surgical excision followed by reconstruction and consideration of adjuvant therapy. A thorough evaluation, including biopsy and imaging, would be necessary to confirm the diagnosis and tailor the treatment plan to your specific case.

Please consult with your treating physician to discuss these recommendations and to determine the best course of action for your condition.

Sincerely,

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

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