GOOD MORNING!

Malignant ulcer of
tongue :
A preoperative case.

Dr. Arnob Barua David

Resident (Phase B),
Department oral & maxillofacial surgery,
BSMMU.
Particulars of the
patient
Name: Mrs. Aleya Begum
Age: 60 years
Sex: Female
Occupation: Housewife
Address: Rajshahi
Bed no: FNP 29
Date of admission: 30/10/2017
Chief complaints

• Non healing ulcer on left side

of the tongue for 2 months.
• Moderate to severe pain for 20
days.
History of present
illness

• According to the patient she was apparently

well 2 months back. Then she noticed an
ulcer on left side of the tongue. Initially it was
small in size, then started increasing rapidly.
• She also complained of moderate to severe
pain for last 20 days. Pain is constant,
throbbing in nature, does not radiate,
aggravated by eating and relieved by taking
some analgesics.
• With these complaints she admitted to this
hospital for further management.
• Past medical history: Nothing contributory

• Past surgical history : Nothing contributory

• Drug history: Nothing contributory

• Immunization history: Partially immunized

 Personal history

• Have been taking 10 to 15 betel

quid for 30 years.
• Post-menopausal
• Mother of four children
• Belongs to middle class family
General examinations

Appearance: anxious

Body built: average

Decubitus: on choice

Anemia: absent

Jaundice: absent

Cyanosis: absent

BMI: 19.5
Vital parameters

Blood pressure- 150/90 mm(Hg)

Pulse rate- 72 beat/min

Temperature- 98.4 F

Respiratory rate- 15 cycle/min

 Systemic examinations

Respiratory
system

Cardiovascular system
Urinary system
Nervous system

GIT system

Revealed normal
Examination of face

o A swelling on the left

submandibular region
causing facial
asymmetry
o Skin color is normal
o No scar mark
o No ulceration
o TMJ revealed normal
o No sign of paresthesia,
numbness and facial
palsy.
Examination of
neck
o Single, Palpable, tender & hard
IB group of lymph node on left
side, measuring about 2cm in
greatest dimension. Overlying
skin is free.

o Single, Palpable, tender, hard and

mobile IIA group of lymph node
on left side, measuring about 1.5
cm in greatest dimension.

o Single, Palpable, tender, hard and

mobile IV group of lymph node
on the left, measuring about 2
cm in greatest dimension. It is
free from overlying skin.
Intra-oral examinations

• Maximum inter incisal opening is about 4O

mm.
• Poor oral hygiene
• No missing teeth
• There is an ulcer in left lateral border of
the tongue involving left side of floor of the
mouth and left side of the lingual gingiva.
• Marked restriction of tongue movement.
Examination of ulcer:
inspection
• Number- single
• Site- left lateral border of
tongue.
• Extension:
o Left Lateral border of anterior 2/3
and posterior third of the tongue
o Whole left floor of the mouth
o left lingual gingiva (mandibular
canine to third molar)
• Size- 5×1.5 square cm.
• Margin- irregular
• Shape- irregular
• Edge- everted
• Floor- Covered with white
necrotic slough
Examination of ulcer:
palpation
• Tender
• Edge is everted and
indurated
• Floor bleeds on touch
• Base is indurated and fixed
with underlying structures.
• Tongue movement is
restricted
• There is numbness on the
left side of the tongue
• Lower lip sensation is
intact
Provisional
diagnosis

• Malignant ulcer of
tongue
 Differential
diagnosis

Malignancy of
Oral Squamous minor salivary
cell carcinoma gland
Date: 28 October
2017
CT scan: axial view
Date: 28 October
2017
CT scan: axial view
Date: 28 October
2017
CT scan: axial view
 CT scan: coronal view

Date: 28 October
2017
 CT scan: coronal view

Date: 28 October
2017
 Histopathology report
Date: 24 October 2017

• Incisional biopsy: Early

invasive squamous cell
carcinoma - well to
moderately differentiated

• FNAC of Submandibular
swelling- Purulent materials
with numerous necrotic
inflammatory cells.
Confirmatory diagnosis

• Squamous cell carcinoma of

tongue.
• Stage IV (T4a, N2b, Mx)
 Treatment plan:

Elective tracheostomy
Surgical approach
Surgical approach
Surgical approach
Surgical approach
Surgical approach
Thank you!