Squamous cell carcinoma

Case study
 INTRODUCTION
● NAME :
Baghwan
Das
● AGE : 65

yrs

● SEX :Male
CHIEF COMPLAINT

• Patient complain of painful ulcers in the

lower front tooth region since 15 days.
HISTORY OF PRESENT ILLNESS
• Patient was apparently well 1 month back when he experienced
pain in the lower front region and lower left back region of
mouth. Pain was gradual In onset and progressive in nature and
of intermittent type.Pain used to get relieved on medication.
• After one week patient noticed a painful ulcerated growth in front
lower region of mouth This growth was graduAl in onset and
progressive in nature.
• Pateint also complains of dry mouth and restricted tongue
movement
PAST DENTAL HISTORY

• Pateint has an extraction of tooth 36 ,ten

days back.
PAST MEDICAL HISTORY

• Patient is hypertensive and is on medication

for the same.
PERSONAL HISTORY
• Patient is not habitual of regular brushing
and hardly brushes once a week.
• Patient is on mixed diet.
• Chronic smoker.smokes 2 packs of Bidis/day
since 20 yrs.
• Occasionally alcoholic.
• No other related habits.
FAMILY HISTORY

• Not significant
GENERAL EXAMINATION

• VITAL SIGNS.:
• Pulse : 80beats/min.
• BP : 140/90mmhg.
• Respiratory Rate : 20breath/min
HEAD AND NECK EXAMINATION

• LYMPH NODES :
• Two to three submandibular lymph nodes
were palpable.
• Non Tender,stony hard and fixed to
underlying structures.
EXAMINATION OF ORAL CAVITY
• EXTRA-ORAL EXAMINATION
• Mouth opening: normal
• TMJ opening: normal
• No tenderness,no clicking sound and no
deviation were present.
INTRA-ORAL EXAMINATION

• SOFT TISSUE:.
• Lip : lips were darKish in colour.
• Buccal mucosa : greyish white wrinkled
surface which disappears on stretching.
• Vestibule : Erythematous.
• Tongue : Brownish pigmentation.
• floor of mouth: calculus deposition and
erythematous nodular swelling.
Fig 1.1
 GINGIVA
• Gingiva was swollen.
• PDL pocket was present.
• Erythematous.
• Surface was irregular on maxillary arch and
smooth and tender on mandibular arch.
• Contours were raised.
• Bleeding on probing was not present
•
HARD TISSUE EXAMINATION

• CARIES TOOTH : 37,45,46,47

• RESTORED TOOTH : none.
• MOBILE TOOTH :37
OCCLUSION

• No.of teeth present : 4.

• MISSING: 11,12,13,14,15,16,17 ,
21,22,23,24,25,26,27,31,32,33,34,35,36,41
,42,43,44.
• Shape of tooth: normal
• Stains and calculus : present
• Wasting disease : attrition was present
 INSPECTION
• Ulcero-poliferative lesion
with irregular margins,
present in the labial
sulcus attached to the
mandibular alveolar bone
extending from right
canine to left 2nd
premolar region.
 CONTDD…..

• Lesion also involves the floor

of the mouth
• Lesion measures about
3.4×2.5×3cm..
• No teeth were present in the
region of growth.
PROVISIONAL DIAGNOSIS

• Squamous cell carcinoma present in the

labial sulcus Attached to the mandibular
alveolar bone extending from right side of
the canine to the left 2nd premolar region.
DIFFERENTIAL DIAGNOSIS

• Fibrosarcoma
• Multiple myeloma
• OKC
• papilloma
 INVESTIGATIONS
● OPG FINDINGS:
• Irregular destruction of
mandibular bone
around tooth
extending from
central incisor to
second molar on left
side.
• Floating Tooth 36.
FINAL DIAGNOSIS

• Squamous cell carcinoma present in the

labial sulcus Attached to the mandibular
alveolar bone extending from right side of
the canine to the left 2nd premolar region.
TREATMENT PLAN

• REMOVAL OF CAUSE:removal of any local irritants i.e

smoking,spices, spirit, sepsis and syphilis.
EXCISIONAL BIOPSY: small lesion.
• SURGERY : cryotherapy, laser surgery,and radical surgery.
• RADIOTHERAPY.
• CHEMOTHERAPY