Ich rauche seit 20 Jahren Zigarren und nun glaube ich dass dadurch eine Schwellung an welchen Gaumen entstanden ist. Kann das sein

Initial Analysis:

Based on your history of cigar smoking for 20 years and the presence of palatal swelling, the following three potential diagnoses could be considered:

1. Squamous Cell Carcinoma (SCC):
   • Treatment: Surgical excision, potentially followed by adjuvant radiation or chemotherapy, depending on the stage of the tumor.
2. Nicotine Stomatitis:
   • Treatment: Cessation of smoking and observation for changes in the lesion.
3. Salivary Gland Pathology:
   • Treatment: May range from conservative treatment (antibiotics, sialogogues) to surgical intervention, such as excision of the lesion or gland.

Differential Diagnosis:

Given the significant history of cigar smoking, the following three diagnoses are the most viable:

1. Squamous Cell Carcinoma (SCC):
   • Rationale: Tobacco use is a major risk factor for the development of oral cancers, particularly SCC. A persistent swelling on the palate in a heavy smoker can be a manifestation of this condition. Biopsy of the lesion would be necessary for diagnosis.
2. Nicotine Stomatitis:
   • Rationale: This is a benign lesion directly related to heat from smoking, commonly cigars or pipes. It presents as a diffuse palatal swelling with a characteristic appearance. Cessation of smoking often leads to the resolution of the lesion.
3. Salivary Gland Pathology (Mucocele or Neoplasm):
   • Rationale: Swelling on the palate could be related to salivary gland pathology, such as a blocked duct or a neoplasm. Clinically, it may present differently compared to SCC or nicotine stomatitis. Imaging studies like ultrasound or MRI and fine-needle aspiration may be helpful in the diagnosis.

Treatment Recommendation:

The most appropriate initial step is to obtain a thorough history and conduct a physical examination, including an oral cavity examination to assess the lesion’s characteristics (color, texture, mobility, etc.). The next step would be to perform an incisional or excisional biopsy of the lesion to obtain a definitive diagnosis.

Depending on the histopathological findings, the treatment would be tailored accordingly:

1. For SCC: Referral to an oncological team for staging and management, which typically includes surgical excision of the tumor with clear margins, possible neck dissection, and adjuvant radiotherapy or chemotherapy.

2. For Nicotine Stomatitis: Advising smoking cessation and regular follow-up to monitor the lesion’s regression.

3. For Salivary Gland Pathology: Depending on the specific diagnosis, treatment may range from conservative management to surgical excision of the affected gland or the lesion.

It is imperative to emphasize the importance of smoking cessation regardless of the diagnosis, as it is a significant risk factor for several oral conditions, including oral cancer and periodontal disease.

Citation:

• Warnakulasuriya, S., et al. (2020). Oral health risks of tobacco use and effects of cessation. International Dental Journal, 70(1), 7-30.

Signature:
Michael Truppe, MD

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