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Abstract: The patient discovered a mass on the palatal side of the left maxillary molar region on his own, with no obvious self-conscious symptoms. For a thorough diagnosis, he came to our hospital. After admission, various routine examinations and cervical lymph nodes, hepatobiliary and splenic ultrasound, and pulmonary CT were performed without abnormalities. After repeated pathological examinations, he was diagnosed as atypical hyperplasia, and after communicating with his family, he underwent an enlarged excisional surgery for gum cancer. The postoperative pathology was highly differentiated squamous cell carcinoma, and the postoperative disease was controlled and the quality of life was effectively improved without recurrence.
Basic information】Female, 65 years old
Disease Type】Gum cancer
Hospital】The First Hospital of Harbin Medical University
Date of Consultation】November 2008
Treatment plan】Enlarged gum swelling excision
Treatment Period】20 days of inpatient treatment and 3 months of outpatient follow-up
Effectiveness】The condition has been controlled and there is no local recurrence
I. Initial consultation
The patient found a mass on the palatal side of the left maxillary molar area on her own, without pain or pain to touch. There was a small amount of bleeding on the surface of the mass when she brushed her teeth, and the bleeding stopped quickly, and the mass was growing slowly. Therefore, no examination and treatment were performed, and there was no significant change in weight. In order to seek thorough diagnosis and treatment, he came to our oral surgery outpatient clinic.
On examination, the patient was in good general condition, clear and lucid. The face was symmetrical with normal openness. The hygiene of the whole mouth was poor. Some teeth were missing. A swelling was seen on the palatal side of the left maxillary molar area, about 3 cm × 3.5 cm. slightly above the mucosal surface, with a cauliflower-like surface, clear border, inactive, with elevated marginal gingiva, hard and tough texture, no bleeding when touched, and pain to touch (-). The adjacent teeth were mildly loose, with sharp tips, and no enlarged lymph nodes were palpated in the left neck.
The initial diagnosis was a left maxillary gingival swelling. Curved tomography was performed as an outpatient and no alveolar bone destruction was seen in the lesion area.
II. Treatment history
After admission, all the routine preoperative examinations were performed. Because of the suspicion of gingival malignancy, cervical lymph nodes, liver, biliary and spleen ultrasound and lung CT were performed, but no abnormalities were found. In order to confirm the diagnosis, local pathological examination was performed, and the first pathological diagnosis was severe atypical hyperplasia. The second pathological examination was performed, and the pathological report was moderate atypical hyperplasia. The preoperative pathology results did not support the suspicion of gingival cancer.
Suggested surgical options: 1. Undergo excisional surgery of the mass according to the atypical hyperplasia. If the postoperative pathology was gingival cancer, 2 enlarged resections were performed; 2, direct enlarged resection of the mass.
At present, the early treatment plan for maxillary gum cancer is tumor enlargement resection, which can be performed without simultaneous cervical lymph node dissection. Therefore, communicating with the family, looking at the local lesion performance highly suspected to be gingival cancer, but the current two pathologies are not supported, if it is atypical hyperplasia, incision can be made at the edge of the lesion and lesion excision can be performed, and the clinical performance is very likely to be gingival cancer. However, the preoperative pathological excision range has been relatively large, and still no cancerous tissue has been taken. It was suggested that this surgery should be performed in accordance with gingival cancer to enlarge the swelling and avoid the pain of 2 surgeries. The family agreed to adopt it, and the enlarged gingival swelling was excised under general anesthesia.
III. Treatment effect
After the surgery, the patient’s local condition was closely observed, and there was no local redness, swelling or exudation after surgery. The iodoform gauze package was removed on time and the wound was slowly covered by epithelium. The routine postoperative pathology returned a highly differentiated squamous cell carcinoma, which was consistent with the preoperative clinical judgment. The patient’s family was satisfied with the diagnosis of the disease and the treatment plan adopted. The patient’s family was satisfied with the diagnosis of the disease and the treatment plan adopted, and he was discharged at 20 days of hospitalization with good recovery. The patient was followed up in the outpatient clinic 3 months after the operation, and the patient’s recovery was very good, the disease was controlled, there was no local recurrence, and the quality of life was greatly improved compared with that before the operation.
IV. Precautions
We communicated with the patient’s family that the inconsistency between the preoperative pathology and postoperative pathology indicates that the lesion should be localized cancer, but only the part of the lesion that was not cut before surgery is cancerous, so it is not very serious and should not be overly nervous. We are glad that the patient’s condition is under control. We suggest that the patient should be reviewed regularly to prevent the spread of cancer or other lesions. Observe whether there are local proliferations and bleeding to achieve timely detection and treatment.
Since the etiology of the patient’s malignancy is unclear, it is recommended to remove local stimuli and prevent recurrence of cancer due to repeated chronic stimuli, such as restoring missing teeth, sharpening sharp tooth tips, avoiding stimulating gums or buccal mucosa, and also trying to avoid eating overheated food to stimulate gums.
V. Personal insight
If dental discomfort occurs in daily life, it is important to consult a doctor in time to investigate the specific cause and treat it early to prevent delay in treatment, which may lead to aggravation of the disease. After the surgery, you should closely observe your symptoms and actively treat them under the guidance of doctors. After effective treatment, you should stay away from the factors that may cause gum cancer and actively prevent the recurrence of gum cancer, such as paying attention to oral hygiene, brushing teeth on time, eating less food that is harmful to teeth and reducing stimulation to the gum area. And after the surgery, you should go to the hospital regularly for review according to the doctor’s instruction to observe whether the cancer has metastasized and to monitor the recovery of the disease. In case of dental discomfort, it is necessary to seek timely medical consultation for symptomatic treatment.