Palatal lesion : Is it serious Doctor ?#2
Describe the lesion :
Paramedian ulceration with a necrotic bottom, associated with a non suppurating loss of substance leaving the palatal bone exposed. It has irregular edges and rests on a healthy palatal mucosa membrane facing 25.
Diagnostic hypothesis :
- Post-surgical osteitis due to a serious tobacco intoxication.
- Differential diagnostics :
- Neoplasia : in the presence of any chronic mouth ulceration, a cancer must be taken into consideration. The context of the appearance of this ulceration, the patient’s general condition and the absence of adenopathy, the scanner data and the leading edge of migrating keratinocytes of the lesion did not lead us to carry out a biopsy as first intention.
- Other osteitis : bisphophonate osteonecrosis, post-traumatic, sinus etiology…
Additional examination :
- A scanner was done.
- A bacteriological would not have been useful (no suppuration)
- An anatomopathological analysis and a biopsy would have been vital in the case of the worsening of the lesion despite a well medical treatment observance.
- Tobacco and smoking cessation.
- Antibiotic therapy: Amoxicilline 3g/day, FLAGYL 1,5g/day until the palatal mucosa has completely healed.
- Clinical monitoring to check the wound healing process.
- No surgery has been carried out in the absence of suppuration and bone sequestration.
If the lesion does not heal despite the cessation of tobacco smoking and the antibiotic treatment, A BIOPSY AND AN INVESTIGATION REGARDING A MALIGNANT TUMOR MUST BE CARRIED OUT.