Dear Patient,
Based on the information you have provided, it appears that you have a history of oral mucosal changes dating back to late 1917, with the most recent development being an ulcerative or leukoplastic growth on your jaw and palate. The fact that the initial swelling in the soft palate resolved with cigar use suggests a possible psychogenic etiology, but the current presentation raises concerns for a potentially malignant process.
Your description of the current lesion being ulcerous or leukoplastic is consistent with various oral mucosal disorders, including epithelial dysplasias and squamous cell carcinoma. The uncertainty regarding the diagnosis by Dr. Felix Deutsch further emphasizes the need for a definitive evaluation.
Given your history and current symptoms, it seems appropriate to pursue a thorough diagnostic workup to rule out malignancy. A rhinologist is an excellent choice for managing this condition due to their expertise in nasal and sinus conditions as well as related oral and maxillofacial pathologies. However, I would also recommend consulting with an oral and maxillofacial surgeon or a specialist in oral pathology for further evaluation and potential biopsy of the lesion.
Alternative treatments may include topical therapies such as antifungal agents for candidiasis or corticosteroids for inflammatory conditions, but these should be considered only after a definitive diagnosis has been established. In cases where malignancy is confirmed, surgical resection with appropriate follow-up care will likely be the most effective treatment option.
I strongly advise you to continue seeking professional medical advice and to undergo the recommended diagnostic procedures as soon as possible. The earlier a diagnosis is made, the better the chances for successful treatment and improved outcomes.
Sincerely,
Prof. R. E.
2024-01-31 14:01 Telekonsultation
Hans Pichler (1877 – 1949)
Head of the Maxillofacial Surgery Department
First Surgical University Clinic
Dear Patient,
Based on your medical history, the initial occurrence of a painful swelling in the soft palate in late 1917 and its subsequent resolution after smoking cigars suggests that this lesion may have been psychogenic in nature. However, the current presentation with an ulcerous or leukoplastic growth on the jaw and palate raises concerns for a potentially malignant process.
Felix Deutsch’s diagnosis of “bad leukoplakia” is plausible, as leukoplakia refers to a white, raised, non-neoplastic lesion of the oral mucosa. However, it is essential to consider alternative possibilities, such as squamous cell carcinoma or other malignant conditions that may present with similar clinical features.
Given the current evidence, I would recommend further diagnostic evaluations before proceeding with surgery. These tests may include a biopsy of the lesion for histopathological examination, as well as imaging studies such as panoramic radiography or computed tomography to assess the extent of involvement and potential spread to surrounding structures.
It is important to note that rhinology, while valuable in managing certain nasal conditions, may not be the most appropriate specialty for addressing this oral lesion. Maxillofacial surgery, specifically, offers expertise in the diagnosis and treatment of various oral and maxillofacial pathologies, including malignant conditions.
In light of the newest medical publications, our understanding and approach to managing oral malignancies have evolved significantly since 1923. In 2024, we would likely employ more advanced diagnostic techniques and treatment modalities, such as minimally invasive surgical approaches, targeted therapies, and adjuvant treatments like chemotherapy or radiation therapy.
I strongly advise you to consult with a maxillofacial surgeon for further evaluation and management of your current condition. This specialist will be best equipped to provide an accurate diagnosis and develop an individualized treatment plan tailored to your specific needs.
Should you have any questions or concerns, please do not hesitate to contact me or my team at the First Surgical University Clinic.
Sincerely,
Hans Pichler (1877 – 1949)
Head of the Maxillofacial Surgery Department
First Surgical University Clinic
Termin vereinbaren
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Albertgasse 3/6 1080 Wien
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