My name is Sigmund Freud. It is currently February 2024. What would have been the recommended treatment for my palatal ulcerous lesion at the time? I had been using cocaine to alleviate my nasal swelling since 1895. Could there have been a link between my cocaine use and this palatal ulcerous lesion that was treated incorrectly? Was Radiotherapy and Resection ever indicated? Would it have made a difference for my quality of life?

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Feb 4, 2024

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Teleconsultation

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Prof. R. E.
University Vienna

Dear Mr. Freud,

I appreciate your inquiry regarding the treatment for palatal ulcerous lesions during the late 19th and early 20th centuries, specifically in the context of your cocaine use. Based on the information provided from the American Journal of Rhinology (2003), it appears that palate perforations were relatively uncommon among cocaine abusers, occurring in approximately 24% to 30% of cases.

Given your history of cocaine abuse and the development of a palatal ulcerous lesion, it is plausible to consider a causal relationship between these conditions. The ulceronecrotic process induced by cocaine abuse may extend anteriorly to involve the columella and soft tissues of the nasal pyramid and upper lip, as observed in some cases.

In terms of treatment, the literature from that era suggests several approaches for managing palatal perforations, including:

Conservative management: This approach involves the use of topical agents such as antiseptics or debridement to promote healing. However, this method may not be effective in cases with extensive ulceration or perforation.
Surgical intervention: Depending on the size and location of the perforation, surgical repair using local flaps or grafts might have been considered. This approach aims to restore the structural integrity of the palate and improve function and aesthetics.
Radiotherapy and resection: In cases with extensive ulceration or perforation that do not respond to conservative or surgical management, radiotherapy and resection may be indicated. Radiotherapy can help reduce inflammation and promote healing, while resection is used to remove non-viable tissue and restore the palatal structure.

Given your history of cocaine abuse and the potential for extensive soft tissue involvement, it is possible that a more aggressive approach such as radiotherapy and resection could have been considered in your case. However, it is essential to note that the available literature from that era does not provide sufficient information on the use and efficacy of these treatments for palatal ulcerous lesions related to cocaine abuse.

As for the impact on your quality of life, it would depend on the severity and location of the palatal ulcerous lesion. In cases with extensive involvement, speech and swallowing difficulties could occur, leading to significant impairment in daily functioning. Effective treatment, such as surgical intervention or radiotherapy and resection, could help improve these symptoms and enhance your overall quality of life.

I hope this information provides some insight into the potential treatment options for palatal ulcerous lesions during that era and the possible connection to cocaine abuse. If you have any further questions or concerns, please do not hesitate to contact me.

Sincerely,

Prof. R. E.
University Vienna

2024-02-04 17:34 Telekonsultation

Based on the information provided in the context, your palatal ulcerous lesion was first identified in 1917. At that time, the adverse effects of cocaine on the nasal tract, including septal perforation, were already known (Owens, 1912). However, the link between cocaine use and palatal ulcerous lesions was not well established at the time.

The initial treatment for your palatal ulcerous lesion in 1923 involved an excisional biopsy of the lesion under local anesthesia by Dr. Hans Hajek, resulting in incomplete tumor removal and severe postoperative bleeding. The corrective surgery was then planned by Prof. Pichler, who performed a partial resection of the right maxilla and mandible, followed by histologic examination that failed to identify any sign of malignancy.

Given the information available at the time, the most likely treatment advices for your palatal ulcerous lesion would have been:

Surgical excision with wide margins: This approach was taken in 1923 by Dr. Hans Hajek, but it resulted in incomplete tumor removal and severe complications.
Radiotherapy: The use of radiotherapy for the treatment of palatal ulcerous lesions was not yet established at the time. However, given the potential link between cocaine use and malignant changes, this option could have been considered.
Conservative management: This approach would involve avoiding cocaine use and managing symptoms with pain relief medications and supportive care.

Based on the context, it appears that no radiotherapy was indicated until 1934 when a premalignant lesion appeared. However, considering your history of cocaine use and the potential link between cocaine and malignant changes, radiotherapy could have been considered earlier as an adjuvant therapy to surgery or even as a primary treatment option if the surgical approach failed or was not feasible due to the extent of the lesion.

The use of radiotherapy in your case might have made a difference for your quality of life by reducing the risk of recurrence and improving the chances of successful obturator prosthesis fitting, which was a significant issue throughout your treatment journey. However, it is important to note that radiotherapy also comes with its own risks and side effects, such as xerostomia (dry mouth) and radiation-induced mucositis, which could have impacted your overall wellbeing.

In conclusion, based on the information available at the time, the most likely treatment advice for your palatal ulcerous lesion would have been surgical excision with wide margins. However, given your