Fortis Escorts Hospital Faridabad treated a 60 year old man presented with complaints of ulcer in floor of mouth, pain and slurred speech. Diagnosis through various tests revealed that the patient was suffering from locally advanced tongue cancer. The surgical procedure to treat the patient was led by Dr. Nitin Singhal, Surgical Oncologist, Fortis Escorts Hospital Faridabad. The plastic and reconstructive surgery required to reconstruct the tongue was led by Dr. Surendra Chawla, Sr. Consultant, Plastic & Reconstructive Surgery, Fortis Escorts Hospital Faridabad.
The patient, (name), was a chronic tobacco chewer and an alcoholic and had presented with persistent suffering from pain in mouth and inability to eat and talk over two to three months. Examination revealed an ulceroinfiltrative lesion arising from ventral surface of tongue involving the entire floor of mouth, involving almost entire anterior two thirds tongue and closely abutting the mandible in the entire length. In this advanced state of the disease the case presented multiple challenges to the doctor. The operable condition of the patient was an impetus for the doctors to not only surgically remove his tongue but also reconstruct the organ to restore his speech partially.
What posed further challenges in the surgical procedure was that although the surgery was technically possible it involved the complete removal of almost entire tongue floor of mouth. Additionally, in most circumstances it would have required the removal of almost entire jaw bone and the morbidity that would have been caused would be profound.
To reduce the morbidity factor while not compromising the oncological safety a marginal mandibulectomy along the entire length of lower alveolus i.e upper half of jaw bone was removed along the entire length, right from the right second molar to left third molar. This could have resulted in fracturing of the jaw bone which would have made its removal imperative. On the other hand that would have defeated the purpose of achieving dual objectives that is oncological safety and adequate removal and preservation the contour of the lower jaw and face to give a good cosmetic and functional outcome. The team of doctors reconstructed the defect and tongue using skin and tissue from the leg.
Dr. Nitin Singhal, Surgical Oncologist, Fortis Escorts Hospital Faridabad said, “The treatment had been delayed for over a month owing to the misconception and fear that surgical procedures will lead to a significant deformity and disfigurement as patient had seen few of similar patients treated at other hospitals having a deformed face post a surgical procedure in his neighborhood. This had resulted in further complexity of the case and the treatment to be followed. But our endeavor was to treat this patient to the best of our ability and the best of his satisfaction.”
The patient expressed his gratitude to the doctors, “Today, I am doing good and able to eat semisolid foods comfortably and my speech quality has also improved. The pain I have suffered cannot be expressed in words. I could not eat or swallow or talk and my life was a journey of suffering. I am really thankful to the doctors for alleviating me from the pain caused by the medical condition I was in.”
India has a high incidence of oral cancer as 4 in 10 of all cancers are oral cancers. It also attributes to the most common cancer. Annually, as many as 14 deaths every hour occur in India as people suffering from oral cancer succumb to it. Estimated to be around 130,000, the highest prevalence of oral cancer in India is primarily because tobacco is consumed in the form of gutka, quid, snuff or misri. India is also estimated to house about 40% of world’s smokers and this has contributed to the trend of numbers rising. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes.
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