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45 year old with carcinoma of right parotid

This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs

A 45 year old male patient farmer by occupation came with c/o  painless swelling on right side of face since 5 months 


Patient was apparently alright 1 1/2 year back then noticed  Swelling on right side of face ,painkess ,initially small in size later increased in size  for which he went to a hospital where he was diagnosed to be having pleomorphic adenoma and superficial parotidectomy was done  7 months back ,then pt c/o gradual increase in size of  right parotid gland since 5 months again
And c/o painful oral ulcer at right retromolar trigone since 4 months 
N/K/C/O DM,HTN,BA,EPILEPSY, TB

Personal history-
Appetite -normal
Diet-mixed
B&B -regular
Addictions- pan daily 2 since 7 years 





Outside Investigations-

General examination -
Pt is c/c/c
Bp-120/80mmhg
PR-78bpm
RR-18cpm
Grbs-148mg%
No pallor, icterus, cyanosis, clubbing, lymphadenopathy 

Systemic Examination-
CVS-S1,S2+,No murmurs 
RS-BAE+,NVBS,No added sounds
P/A-soft,non tender
CNS-
HMF+
GCS-15/15
POWER
        RT        LT
UL- 5/5       5/5
LL- 5/5        5/5
Reflexes-
        Rt               Lt
B       ++               ++
T       ++                ++
S        ++               ++
K         ++                ++
A         ++                 ++
P    dorsiflexion

L/E-painless swelling of size  6 x 7 cm on right side of face below ear lobule ,hard in consistency ,non tender ,well defined margins,smooth surface
No local rise of temperature 
Ear lobule not raised 
Curtain sign -positive
No signs of facial nerve involvement

Examination of Oral cavity-angle of mouth deviated to left
Grade I trismus
Black stains over teeth
1 x3 cm ulceroproliferative growth over right RMT and buccal mucosa 3-4cm behind angle of mouth
Tongue movements-normal
Oropharynx-
Anterior pillars pushed forward
Right tonsil pushed medially


Diagnosis-RIGHT CARCINOMA OF PAROTID WITH RIGHT RMT ULCER







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