A PREOPRATIVE CASE OF VERRUCOUS CARCINOMA OF BUCCAL MUCOSA AND LOWER LIP

Dr. Dwarika Prasad BajgaiMS Residency Phase BOral and Maxillofacial Surgery Department BSMMU

Patient Particulars

• Name- Paresh Chandra Debnath• Age- 68 years• Sex- Male• Address- Nohakali• Date of Admission : 17-05-2014• Date of history recording:19.05.14

Chief Complaints

• Swelling in left side of the inner cheek since last 5 months

History of Presenting illness

According to the statement of patient, he was relatively well 5 months back. Then he felt something unusual while brushing by finger in the inner left cheek region. He discovered it as small swelling. It was painless and did not cause any discomfort. At the same time he had breathing difficulty problems , so he sought treatment for respiratory problems. He ignored the oral problem . But in the last 15-20 days Contd..

he noticed increasing size of lesion . There was no associated pain, no bleeding ,and no discharge from the lesion . He consulted nearby dentist for the problem and was referred to BSMMU for better management .

Past History

• Past Medical History-COPD since last 5 years• Past Dental History- NRH• Drug History- Mast cell inhibitor (Montelucast) 10mg od ,

Salbutamol inhaler 2 puffs twice daily• Personal History-

• Smoking 50 pack years• Pan with betel nut with tobacco and without lime since last 45 years

• Immunization history- Non immunized• Socioeconomic status- middle class family

General Examination

• Appearance- Well oriented to time, place and person• Built- Average built• Nutrition- Average nourished• Decubitus- on choice• Icterus-• Pallor-• Cyanosis- NAD• Dehydration• Edema-• Lymphodenopathy-

Vitals

• Blood Pressure – 128/84 mm of Hg• Pulse- 68/min• Respiratory Rate- 14/ min• Temperature- Afebrile

Systemic Review

• Cardiovascular• Neuromuscular Non contributory• Gastrointestinal• Genitourinary• Respiratory-no shortness of breath,chest

symmetrical in shape,trachea central,chest expansion equal in both sides,resonant sound on percussion of both lung fields, Breath sounds vesicular

Extraoral Examination• Inspection and palpation

Face- symmetrical Range of movement of mandible-normal

Lymph nodes-not palpable, not enlarged, non tenderNo any other significant abnormalities detected.

Intraoral Examination

• Inspection-Mouth opening adequate -oral hygiene poor

-pinkish, flat ,raised lesion 3cm x 4cm on left buccal mucosa with some white keratin like material distributed evenly in the lesion, lesion extends up to the left angle of mouth touching vermilion border of lip , lesion does not extend into vestibule and limited to buccal mucosa. At the end of anterior extent of lesion there is an well circumscribed exophytic growth 1cm x 0.5 cm, white in color.- no any associated bleeding , ulceration,sloughor discharge associated with the lesion.

• Palpation– Buccal mucosal lesion non- tender, soft to

firm in consitency,– base not indurated,– Exophytic growth sessile, non-tender , firm to

hard in consistency

Salient Features• Mr. Paresh Chandra Debnath, 68 yrs male, hailing from Nohakali presented with the c/c of

swelling in the left inner cheek since last 5 months . The swelling was initially of small in size , but in last 15 days patient observed increasing in size . There is no associated pain and bleeding . Pt. has m/h of COPD since last 4 years and now in a well controlled status.Pt. has a h/o of smoking 50 pack years and betel nut chewing with tobacco and without lime for last 45 years.On extraoral exmination, no significant findings noted. No lymph node is palpable , enlarged or tender . Jaw movement is normal.On intraoral exmination, mouth opening is adequate, oral hygiene fair. There is a lesion on left buccal mucosa , 3cmx4cm in size, flat raised , pinkish in color, with white keratin like material interspersed in lesion, extending posteriorly from near 2nd molar area to the left corner of mouth near vermilion border, and one exophytic lesion 1cm x0.5cm , sessile and white in appearance. Lesion is non-tender, soft to firm in consistency, non-indurated, not fixed to underlying structures . With all these chief complaints and clinical findings , pt. was admitted to BSMMU OMFS ward for better treatment

•

Provisional Dignosis

• Verrucous Carcinoma

• D/DX– Proliferative verrucous leukoplakia– Papillary squamous cell carcinoma– Verrucous hyperplasia

Investigations

Specific-Incisional Biopsy and histopathology-Indirect laryngoscopy and Nasoendoscopy-opg

• For GA fitness– Blood for Hb, CBC,TC, DC,ESR, RBS, S.

creatinine– CXR P/A view– ECG– Blood grouping– Anti-HBsAg, Anti-HCV

Histopatholgy Report

• Incisional biopsy and histopatholgy done on 17-03-2014– Verrucous carcinoma

Treatment Plan

• Wide excision of lesion with minimum 1cm of clinically appearing healthy margin with primary closure .

• Follow up at every 4-months for 2 years followed by every 6 months there after.

Prognosis

• Excellent• Cure rate 80 %

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