Carcinoma of tongue /dental courses

SymposiumSymposium
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

Carcinoma of theCarcinoma of the
TongueTongue
Diagnosis & ManagementDiagnosis & Management

A Patient by name Mr. Annu, aged
35yrs reported to the Dept of Oral
& Maxillofacial surgery with the
Chief Complaint

Pain in the Right side of the
tongue since 2 weeks

Pain :
sudden
moderate
non radiating
increases on chewing
decreases on
medicationwww.indiandentalacademy.com

Also presents with an ulcerulcer
in the tongue since 1 year on
the ventral surface
No discharge.

No H/O
increased salivation,
impairment of speech &
decreased tongue movements

Dental & Medical History –
Nothing significant
Family history – Married
with 2 children

Personal history –
brushes with brush & paste
once daily
No H/O exposures

HABIT INDEX
Betel nut chewingBetel nut chewing ::
 6 times/ day with baked lime
soda.
No habit of keeping the quid
inn the vestibule.
Since 20 yrswww.indiandentalacademy.com

SMOKING
10 beedis per day since 25 yrs
NON – ALCOHOLIC.
MIXED DIET & EATS
SPICY FOODwww.indiandentalacademy.com

GENERAL EXAMINATIONGENERAL EXAMINATION
Moderately Built & Moderately
Nourished.
NO Pallor
Icterus
Cyanosis
Clubbing
Edema www.indiandentalacademy.com

EXTRAORALEXTRAORAL
EXAMINATIONEXAMINATION
No gross facial asymmetry.
TMJ – Normal

INTRAORAL EXAMINATIONINTRAORAL EXAMINATION
No Abnormality detected in
intraoral soft tissues except an
Ulcer on the Tongue.
Poor Oral Hygiene.

No sharp teeth
Generalized attrition
No mobility of the teeth

Description of theDescription of the
Intraoral LeisionIntraoral Leision

Inspection
A roughly oval 2 x 1.5 cm
ulceroproliferative leision on the
right ventral surface of tongue in
the middle 1/3 rd.
 Everted margins

Covered by whitish gray Slough
No Serosanguinous discharge.
Surrounding area appears to be
normal with slight inflammation.

Palpation
Inspectory findings confirmed.
Tender
Irregular margins & everted
edge.
Induration is Present.
Doesn’t Bleed

Lymph NodesLymph Nodes
Right level Ib & IIa lymph
nodes palpable,
non-tender,
mobile &
approx 1.5 x 1.5 cms

Left Level Ib lymph nodes
palpable
non-tender
fixed
1.5 x 1.5 cms

Provisional DiagnosisProvisional Diagnosis
Squamous Cell Carcinoma of
the right ventral surface of
tongue

Differential DiagnosisDifferential Diagnosis ::
Tuberculous Ulcer
Traumatic ulcer
Syphilitic ulcer

InvestigationsInvestigations
Biopsy – Incisional
2 bits of tissue from
a. Rt anterolateral border
b. Rt inferolateral border

Specimen
a. shows infiltrating squamous
cell carcinoma -
Well Differentiated type
b. shows in-situ stage squamous
cell carcinoma –
Well Differentiated

Hb % - 14.2 gm %
Blood Group – B ‘Positive’
ESR – 18 mm/hr
TC , DC – Within normal limits.

CXR – PA View & ECG
Nothing Significant
HIV & HBS Ag – Negative

FINAL DIAGNOSISFINAL DIAGNOSIS
Well Differentiated
Squamous Cell Carcinoma
of Rt ventral surface of
tongue

TNM StagingTNM Staging
T2 N2CMO
Stage – IV A

MANAGEMENTMANAGEMENT
Stopping the Habit
To maintain good oral
health
Surgery
Post-Surgical Radiotherapywww.indiandentalacademy.com

SURGERYSURGERY
Plan
Wide Excision +
Primary Closure +
B/L SOHND Under GA

INCISION
Submandibular or
Upper part of Mac Fee.
From Mastoid Process
to Chin area

Level Ia, Ib, IIa, IIb, III
should be excised Bilaterally
Submandibular gland removal
is also necessary.

Drain fixation
Primary closure

COMPLICATIONSCOMPLICATIONS
Intra operative Anaesthesia
Intra operative Surgical
* Marginal Mandibular Nerve
injury

Spinal Accessory Nerve
injury
Vascular injury –
CCA, ECA, ICA & IJV.

POST OPERATIVE
wound dehiscence.
infection
speech problems
dysphagia

Carcinoma of tongue /dental courses

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