Reference no: EM133249305
Case: H.R. a 70-year-old woman who initially went to her dentist with a 2-year history of ill-fitting dentures and oral discomfort, and right-sided otalgia. The following are her other relevant complaints:
• experienced a 20lb weight loss, attributed to pain with eating.
• with past medical history of sarcoidosis and hypertension.
• mentioned to have 30-pack year cigarette smoking history and used alcohol on a regular basis when she was younger as she was a tourist guide and would need to accompany some tourist while drinking though she claims it was just small amounts
Course of Illness
H.R. was then referred by her dentist to your hospital for evaluation by a head and neck surgeon. Examination of the oral cavity was significant for an ulcerated mass of the right hard palate extending past the midline anteriorly and involving the ipsilateral maxillary alveolar ridge.
The area was tender to palpation. The mass was considered suspicious for malignancy. There were no other oral cavity or oropharynx lesions and the neck was without lymphadenopathy.
Diagnostics:
A contrast-enhanced CT scan of the neck revealed a 3-cm enhancing mass involving the right anterior maxilla/hard palate . This was associated with bony destruction of the anterior mandible.
The mass crossed the midline anteriorly and involved the soft tissues that form the right nasolabial fold. Coronal reformatted images demonstrated bony destruction extending to the antero-inferior bony nasal septum. There was no lymphadenopathy within the neck.
Laryngoscopy revealed an exophytic well-demarcated friable tumor of the anterior mandibular alveolus crossing the midline, with extension to the labial and buccal mucosa but no significant involvement of the buccal or labial mucosa itself. Lingually, there was extension to involve the hard palate, but the soft palate was not involved.
Diagnosis: The pathology revealed a 4.1-cm invasive keratinizing squamous cell carcinoma of right maxillary alveolus. Carcinoma invaded through bony maxilla into right lateral nasal wall.
Question:
Make a pathophysiology diagram starting from the risk factor ending with her relevant signs and symptoms from the case given above