Red flags in oral submucous fibrosis

Pain

Bleeding

Halitosis 

Loose teeth

Recent onset trismus 

These are red flags to suspect malignancy in Oral sub mucous fibrosis. 

Leukoplakia of tongue

I

Leukoplakia of tongue is very common in India because of rampant use of tobacco products and poor orodental hygiene.


How do we treat Leukoplakia?
Leukoplakia is a potentially malignant Disorder
Other lesion is erythroleukoplakia, which is more sinister

Incidence off oral cancers is 50-100 times higher in Leukoplakia.
The progression is difficult to predict.
In whom  and when cancer develops is unpredictable.

And how we do prevent progression of Leukoplakia to cancer?

•Smoking cessation • Moderation of alcohol use • Diet with adequate antioxidants • Improve oral hygiene I Trauma/ eliminate candida 'Surgical excision of high risk lesions • Surveillance • • 


Grade of dysplaia is important
Anatomical location has prognosis value.
Ploidy analysis has prognosis value.

Colour
Location
Dysplaia
Ploidy

Since most of leukoplakia are asymptotic the intervention objective is to prevent malign transformation

Chemoprevention trial
The COCHRANE COLLABORATION is gold standard

Electronic cigarettes is not therapeutic option
DRINKSMETER
To identity weekly alcohol abuse.
Improve diet
Anything yellow

Happy to be ACLS Certified now.

ACLS Certification

Health program on Ear, nose, Throat diseases Part 1.flv

Bilateral thick tympanic membranes with normal middle ear

Note thickened ear drum on both sides with normal middle ear and mastoid air cells.

HRCT Temporal bone-Axial cut. Double click to see whole CT.

The author describes a unique case of bilateral thick tympanic membrane (ear drum) with normal middle ear and air cells.

The patient (50 years male) presented with decreased hearing both sides for last few years. He was treated for otitis media with effusion or white debris in his ear canal with good result. During his last visit, the author noticed that his normal ear drums don't have any landmark and has pink red mucosal color.  A high resolution temporal bone CT was down. 

Coronal CT. Note thick tympanic membranes and superior wall of external auditory canal  on both sides. Middle ear and mastoid air cells are normal.

Note thick tympanic membranes on both sides more on left with normal middle ear and mastoid air cells.

Ranula

Ranula

Identify the three bony canals in three lateral walls of sphenoid sinus.

Sphenoid Sinus with three bony canals in each lateral wall shown by different color arrows.

Sphenoid sinus with three bony canals in its different walls.

Red Optic canal

Green foramen rotundum

Blue. Vidian canal

Post traumatic hematoma with perichondritis with resultant cauliflowerdeformity



Post traumatic hematoma and then perichondritis of pinna which was solely treated by oral antibiotics by general surgeon.

Thickened pinna as seen from behind in a case of post traumatic perichondritis.

Three incisions were given to drain the  hematoma and infected material. two quilting sutures were given to keep the dead space minimum inside.

Same patient with non tender pinna after 2 weeks of surgical treatment coupled with antibiotics.

Same patient as above after surgical treatment. See the irregular surface persisting resulting in cauliflower deformity. Patient in pain free now.

Bilateral pneumatized superior turbinates