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Abstract: The early symptoms of gum cancer are not obvious. If there are gum ulcers or unidentified superfluous organisms, it is important to go to the hospital to clarify the cause in time. The patient in this case is a patient who came to the hospital due to a burned gingiva 2 months ago, the surface mucosa broke down, and the fistula from the mucosal trauma did not heal for a long time. Through the patient’s medical history and the auxiliary examination, the diagnosis was left mandibular gingival cancer and left mandibular cyst. After surgical treatment, the patient recovered well, and there was no recurrence or metastasis in the review.
Basic information】Male, 66 years old
Disease Type】Left mandibular gum cancer, left mandibular cyst
Hospital】The First Hospital of Harbin Medical University
Date of Consultation】March 2012
Treatment plan】Enlarged resection of left mandibular gingival malignant tumor + mandibular bone square resection + left cervical lymph node dissection
Treatment Period】11 days of inpatient treatment, 3 months of outpatient follow-up
Effectiveness】The disease was controlled, no recurrence or metastasis, etc.
I. Initial consultation
The patient reported that she was burned by water on the labial side of the left mandibular anterior tooth 2 months ago, resulting in the breakdown of the surface mucosa, the wound healed slowly, but the residual fistula did not heal for a long time. On clinical examination, a white warty redundancy was seen on the labial side of the gingiva from the left mandibular central incisor to the first premolar, slightly convex on the mucosal surface, with a small amount of bleeding on palpation, tenderness (-), and indistinct boundaries, and a fistula was visible on the surface with a small amount of snow-like mucous-like fluid flow. The left lower 2 teeth were discolored, loose I°, painful to percussion (-), and numbness of the lower lip (-). No enlarged lymph nodes were palpated in the submandibular region, the left submandibular region and the neck. The results of the curved tomography film showed a cyst at the root end of the left mandible, and the pathological examination performed indicated severe atypical hyperplasia of the squamous epithelium of the left mandibular gingiva with focal carcinoma (intraepithelial). He had no previous systemic diseases, no history of chronic diseases, previous cataract surgery, smoked for 40 years with an average of 10 cigarettes per day, and had quit smoking for 1 year, and drank alcohol for 40 years with 3 taels per day. According to the patient’s medical history and auxiliary examination, the preliminary diagnosis was left mandibular gum cancer and left mandibular cyst.
II. Treatment history
After admission, the general physical examination did not show any abnormality, and various preoperative examinations were performed. The electrocardiogram showed sinus heart rate, mild left deviation of the electrical axis, and right bundle branch block. A frontal and lateral chest radiograph showed secondary pulmonary tuberculosis (fibrosis and calcification) in both lungs. Hepatobiliary, splenic and pancreatic ultrasound showed a mild fatty liver. Panoramic dental imaging of a mandibular cyst, suspected mandibular foreign body, with no localized bone destruction. Curved body layer film showed a cyst in the left lower 2 root ends. The following treatment plan was proposed for the patient based on the examination findings.
1, enlarged resection of left mandibular gingival malignant tumor + mandibular square resection + left cervical lymph node dissection
2.Enlarged resection of malignant tumor of left mandibular gingiva + mandibular osteotomy + left cervical lymph node dissection
Consult with the patient’s family about the advantages and disadvantages of each option. Option 1 has a smaller surgical scope compared with option 2, which can maintain the continuity of the mandible and also keep the function of mandible and stomatology better, and is more aesthetic, with lower surgical cost, shorter surgical time, and less pain for the patient. However, the possibility of recurrence is greater than option 2. After reviewing the above, the patient’s family chose option 1 for the surgery. The patient had an uneventful surgical procedure, removing the gingival surface, alveolar mucosa, including the tumor and jawbone, as well as clearing the lax connective tissue and lymph nodes. The patient recovered well after surgery and was discharged after 11 days of hospitalization, and was instructed to come back for a review in 3 months.
III. Treatment results
The patient’s pathology was focal carcinoma and early stage, and the patient’s recovery was relatively fast after surgery because the surgical option chosen by the patient caused relatively little damage. After surgery, the patient’s mucosal trauma fistula at the site of gingival scald gradually healed, and the patient’s oral function basically recovered, and the incision healed well. The swelling did not recur and did not metastasize, and the recovery was good after 3 months of follow-up examination, and the patient was advised to follow up and review regularly for 2 years after surgery.
IV. Precautions
The patient’s condition was controlled without recurrence or metastasis after treatment, which was very gratifying for the attending physician. However, patients still need to pay attention to the following points.
1. After discharge, the patient still needs regular follow-up examinations, curved tomography, lung CT, cervical lymph node ultrasound and liver, gallbladder and spleen ultrasound to check whether there is any recurrence or metastasis of the tumor.
2. After surgery, first of all, you need to pay attention to oral cleaning, you can do local oral rinsing and drink more water. Secondly, patients need to eat liquid food, such as rice soup, egg flower soup, milk, chicken soup, etc. After a period of recovery, they can eat semi-liquid food, such as puree, egg custard, noodles, etc., and gradually recover from liquid food and semi-liquid food to normal diet.
3, patients need to enhance nutrition after fully resuming normal diet, eat high protein, high vitamin, high fiber diet to promote body metabolism, also conducive to the recovery of their own condition, during this period also need to try to avoid smoking and alcohol, avoid eating spicy, stimulating food.
4, after discharge from the hospital, you need to pay attention to whether there are local masses, pain and other symptoms. If the above symptoms appear, you can go to the hospital for follow-up and timely examination.
V. Personal insight
Through this case, we can learn that if the gums are damaged by improper diet and the ulcers do not heal for a long time, we need to go to the hospital for treatment in time, because the growth of gum cancer in the early stage is slow and there are no particularly obvious symptoms, usually it is mostly ulcers or lumps. Therefore, it is necessary to pay more attention to oral problems and go to the hospital for examination in time to clarify the nature of the unidentified superfluous organisms, so as to detect, diagnose and treat them early and try to cure them through early surgery to avoid irreversible consequences.
The occurrence of gum cancer is mostly related to smoking, alcohol consumption, inflammation, betel nut chewing, etc. The patient in this article has a history of smoking and alcohol consumption for many years, which is also an important reason for the formation of this disease, and we would like to remind everyone to maintain good living habits, stay away from smoking and alcohol, and keep good habits of life and rest.