Sunday, November 8, 2009

Non football-related post

Saw a very interesting case today and can't help not blogging about it.

The patient was an elderly male with only 4 teeth left. His chief complaint was pain in the healing socket where he got a tooth (premolar) extracted 4 days back.

However, there was a very interesting finding in his floor of the mouth, a finding he wasn't aware of. It was a swelling measuring around 1x1cm in size, dome-shaped,slightly reddish in colour, non-tender, and there were also two pinhead-sized yellowish pustules on the peak of the dome-shaped swelling. We, the undergrads with very very limited knowledge, thought we were brilliant to diagnose it as a ranula, since ranula is the typical swelling present in the floor of the mouth. The intern and grad student examining the case weren't sure what it was, and there was absolutely no history of trauma,pain or any prodromal symptoms of infection whatsoever.

The grad student, Dr. Ishita Gupta then consulted a senior grad student, Dr. Poonam Agarwal. Interestingly, Dr. Poonam said that she came across a few cases similar to this one before, and she did a full complete investigation to determine what it was, but there was absolutely no signs of any pathology at all. Her theory is that the swelling is just a hyperplastic tissue response of the tissue of the floor of the mouth to edentulousness. A more interesting fact is that when she tried to find out about similar cases anywhere else, on the internet, scientifec journals,etc, no such cases have ever been documented anywhere.

Wow. I hate examining patients with bad breath (you have no idea how bad), but I sure am going to miss seeing these cases once I finish my course here. Whenever I walk into the clinic every morning at 9 am, it's like walking into a life-sized,real life medical/dental book. So much to learn with so little time.