Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Carcinoma Lip Clinical Examination Discussion and Treatment
Case presentation
Mr. Krishnan
65 years old male
from Teynampet
Working as watchman
Belonging to lower middle class
Came to the hospital with CHIEF COMPLAINTS of
?an ulcer on the right side of lower lip for past 2 years
?Pain over ulcer for past 5 months
History of presenting illness
Patient was apparently normal 2 years back
After which he developed an ULCER
?For 2 years
?Insidious in onset
?Initially small in size
?Gradually progressive
?To attain present size
?Associated with DISCHARGE ? scanty serous,
not foul smelling, not blood stained
History of Presenting illness
PAIN:
?For the past 5 months
?Over the ulcer
?Insidious onset
?Intermittent, pricking type of pain
?Not referred, not radiating
?No aggravating and relieving factors
?H/O difficulty in chewing
?H/O difficulty in swallowing
History of Presenting illness
?No H/O excessive salivation
?No H/O difficulty in opening the mouth
?No H/O difficulty in protruding the tongue
?No H/O deviation of tongue
?No H/O difficulty in speech
?No H/O numbness or paresthesia
?No H/O trauma, evening rise of temperature
?No H/O swelling elsewhere in the body
?No H/O loss of weight or appetite
Past history
?Patient had no similar complaints in the past
?No H/O previous surgery or hospitalization
?No H/O DM, HT, TB, Asthma, Epilepsy, Jaundice
?No H/O ill fitting dentures
?No H/O tooth extraction, sharp tooth
?No H/O STDs
?No H/O chronic drug intake or irradiation
personal history
?Consumes mixed diet
?Normal bowel and bladder habits
?Smoker for past 40 years, 3 cigarettes/day
?Alcoholic, consumes 180ml occasionally
?H/O spicy food intake
?No H/O drug or food allergy
Family history
?No significant family history
General examination
?Patient is conscious, oriented, moderately built
and nourished
?Pallor present
?No icterus
?No cyanosis
?No clubbing
?No pedal edema
?No generalized lymphadenopathy
vitals
?PULSE RATE: 82/min, regular in rhythm, normal
in volume, no specific character, no radio radial/
radio femoral delay, felt in all peripheral pulses
?BLOOD PRESSURE:128/80 mmHg measured in
the right upper arm in sitting posture
?RESPIRATORY RATE: 16/min, abdomino
thoracic
?TEMPERATURE: afebrile
local examination of oral cavity
inspection
After getting consent, the patient is
examined in bright light
LIPS: a single oval ulcer of 3x3cm, in the lower
lip on the right side
Extent:
?Anterior - upto vermillion border
?Posterior - 2cm from lower gingivo buccal
sulcus
?Lateral - 0.5 cm from angle of mouth
?Medial - midline (not crossing the midline)
inspection
?With well defined margins
?Everted and rolled out edges
?Floor has necrotic material
?with serous discharge
?Surrounding skin ? normal
?No scars, sinuses, dilated veins
?No pigmentation
?GUMS : normal
?ALVEOLA : normal
?BUCCAL MUCOSA : normal
?TEETH :
2123 2123
2123 2123
?No dental caries
?No sharp tooth
?No staining of teeth
?Good oral hygiene, no halitosis
TONGUE :
?Pink in colour
?Dorsal and ventral surfaces ? normal
?No ulcers or lesions
?Able to protrude the tongue
?No deviation
?Mobility of tongue normal
RETROMOLAR TRIGONE : normal
FLOOR OF MOUTH : normal
?HARD AND SOFT PALATE : normal
?UVULA: in midline
?ANTERIOR AND POSTERIOR PILLAR : normal
?TONSILS: normal
?POSTERIOR PHARYNGEAL WALL: normal
?TEMPERO MANDIBULAR JOINT: normal, no
restriction of movements
palpation
?Warmth +
?Not tender
?Inspectory findings of site, size, shape, extent are
confirmed
?Hard in consistency
?Base indurated
?Surrounding skin indurated upto 1 cm around lesion
?Mobile
?Do not bleed on touch
?Not fixed to mandible
?No mandibular thickening
examination of lymph nodes
A single, round, mobile, hard lymph node of size
2x1cm palpable in the right jugulo - digastric
region (level 2)
systemic examination
RESPIRATORY SYSTEM:
?Normal vesicular breath sounds heard
?No added sounds
CARDIOVASCULAR SYSTEM:
?S1,S2 heard
?No murmurs
CENTRAL NERVOUS SYSTEM:
No focal neurological deficit
ABDOMEN:
?Soft, non tender, no organomegaly, no free fluid, no
palpable mass
?Hernial orifices free
?External genitalia - normal
diagnosis
?CARCINOMA OF LOWER LIP ON RIGHT SIDE
?INVOLVING LEVEL II LYMPH NODES OF NECK
?WITH TMN STAGING OF T2 N1 M0
?STAGE III
Baseline investigations
?Complete hemogram ? TC, DC, ESR, Hb%
?Urine - sugar, proteins, deposits
?Blood - sugar, urea, creatinine
?Xray chest
?ECG
specific investigations
?Edge wedge biopsy
?USG neck
?FNAC of the node
?Orthopantomogram
?CT for bone invasion
?MRI for soft tissue invasion
?Laryngoscopy
?FOR METASTASIS: Xray chest, USG abdomen
treatment
TUMOR OF SIZE >2 CM
Resection and
Reconstruction
?Abbe's flap (flap based on
labial artery)
?Bernard rotation flap
METASTATIC LYMPH NODE
?Selective supra omohyoid
neck dissection
This post was last modified on 08 August 2021