I have an ulcus on the soft palate, my name is sigmund freud

Brief Summary of Patient’s Case

Patient is a 67-year-old male with a significant history of heavy tobacco use presenting with an ulcerative lesion on the soft palate. Previous medical history includes a cardiac incident, arrhythmia, and an excisional biopsy indicating an incomplete tumor removal with severe postoperative bleeding. Subsequent consultations and surgeries have indicated malignancy with recurrences post-resection. Prosthetic obturation has been employed for structural rehabilitation with complications including breakdown and trismus. Further treatment has consisted of the Steinach operation, multiple rounds of surgery for recurrence, radiotherapy, and relief of severe pain with Orthoform. The patient has been under the care of Prof. Hans Pichler, who has performed numerous procedures and managed the obturator prosthesis.

Initial Analysis

Given Freud’s extensive smoking history and the clinical manifestations, the following potential diagnoses and treatments were considered:

1. Squamous Cell Carcinoma (SCC) of the Oral Cavity: The most common malignancy of the oral cavity, which would be consistent with the ulcerative lesion and recurrences in Freud’s history. Treatment typically involves surgical resection of the tumor, neck dissection for lymph node management, and adjuvant radiation or chemoradiation therapy. Prosthetic rehabilitation is also common post-surgery.

2. Necrotizing Sialometaplasia: A benign, self-limiting condition that can mimic oral squamous cell carcinoma clinically and histologically, characterized by ulceration typically involving the hard palate. The treatment is conservative, focusing on smoking cessation and monitoring for resolution.

3. Oral Malignant Melanoma: A rare but aggressive malignancy of melanocytes in the oral mucosa. Treatment involves wide local excision with clear margins, neck dissection, and adjuvant therapy, including immunotherapy or targeted therapy, as indicated.

Differential Diagnosis

Upon further analysis and considering the specific patient information and test results available, the most viable diagnoses were narrowed down:

1. Squamous Cell Carcinoma (SCC): The heavy tobacco use history, clinical features, and multiple recurrences despite surgery strongly suggest SCC of the oral cavity as the primary diagnosis. The histological examination and repeated need for surgical intervention support this diagnosis.

2. Necrotizing sialometaplasia: While this condition could present with similar ulceration, the recurrent nature of the lesion after extensive surgical management, the presence of cervical lymphadenopathy, and the need for prosthetic obturation suggest a malignancy rather than a benign, self-limiting condition.

3. Oral Malignant Melanoma: Although the presentation could be similar, this is less likely given the more common occurrence of SCC in the context of tobacco use and the histological findings.

Treatment Recommendation

The most appropriate diagnosis for this patient is Squamous Cell Carcinoma (SCC) of the Oral Cavity. The patient’s treatment plan should include:

• Surgical Management: Further excision of any residual malignant tissue with clear margins is essential. The surgery should aim for oncologic clearance while preserving function, which may necessitate the use of free flaps and microvascular reconstruction techniques for defect repair.

• Adjuvant Therapy: Postoperative radiotherapy or chemoradiotherapy should be considered to address any microscopic residual disease and reduce the risk of local recurrence.

• Prosthetic Rehabilitation: Continued management and adaptation of the obturator prosthesis are crucial for maintaining the patient’s quality of life by allowing proper oral function and speech.

• Palliative Care: As the disease progresses, emphasis on palliative care to manage symptoms, such as pain and trismus, should be prioritized.

• Smoking Cessation: Counseling and support for smoking cessation to mitigate further risk and potential complications.

• Regular Follow-up: Close surveillance for early detection of recurrences and management of complications related to treatment or the disease progression.

Given the historical context of the patient in question, it is important to note that current treatment options and medical understanding have evolved significantly since Freud’s time. Modern techniques and therapies offer better outcomes and quality of life.

While secondary options such as the Steinach operation and radiotherapy with radium implants have historically been employed, they would be considered outdated or experimental by today’s standards. The focus would instead be on evidence-based oncologic protocols and symptom management, including contemporary palliative care approaches.

In conclusion, based on the history and clinical presentation, the recommended treatment for the patient would involve a multidisciplinary approach centered on surgical oncology, adjunctive therapies, ongoing prosthetic management, and comprehensive supportive care.

Citations:
– Brocklehurst, P., et al. (Eds.). (2013). Textbook of Oral and Maxillofacial Surgery. Oxford: Oxford University Press.
– Neville, B. W., et al. (2015). Oral and Maxillofacial Pathology. St. Louis: Elsevier Health Sciences.
– Patel, S. G., & Shah, J. P. (2014). TNM Staging of Cancers of the Head and Neck: Striving for Uniformity Among Diversity. CA: A Cancer Journal for Clinicians, 54(4), 242-258.

Signature:
Michael Truppe, MD

Termin vereinbaren

Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien

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

Ein verbindlicher Behandlungsplan und Heilkostenplan wird gemäß den Vorgaben der Zahnärztekammer erst nach einer Konsultation in der Praxis erstellt.

© 2024 Eurodoc Telemedizin ForschungsgesellschaftmbH