--- title: "Clinical Case Discussion: Buccal Carcinoma (Oral Cavity Cancer)" description: "A step-by-step ENT clinical case discussion on Buccal Carcinoma, covering history, examination, diagnosis, and management - ideal for MBBS and ENT students." source: "The ENT Resident" canonical_url: "https://www.theentresident.com/ent-notes-lectures/buccal-carcinoma-case-presentation" categories: ["Clinical Case Presentations"] video: "https://www.youtube.com/watch?v=7R8AXSNANwc" image: "https://media.theentresident.com/og-images/buccal-carcinoma-case-presentation.png" --- # Clinical Case Discussion: Buccal Carcinoma (Oral Cavity Cancer) A step-by-step ENT clinical case discussion on Buccal Carcinoma, covering history, examination, diagnosis, and management - ideal for MBBS and ENT students. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=7R8AXSNANwc ## 🦷 Clinical Case Discussion: Carcinoma of Buccal Mucosa Today, we'll have a clinical case discussion on a very common ENT presentation: **Carcinoma of Buccal Mucosa - Oral Cavity cancer.** This case discussion format will be helpful for both undergraduates and postgraduates. We'll go through the patient's history, discuss how history guides us to a provisional diagnosis, cover the clinical examination findings and their significance, summarize the case, arrive at a provisional diagnosis, and outline the management plan. --- ### 👤 Patient Profile - **Age:** 65 years - **Sex:** Male - **Occupation:** Farmer - **Residence:** Hyderabad ### 🗣️ Chief Complaint - **Ulcer in the inner aspect of the right cheek** since **4 months** --- ### 📜 History of Present Illness - Patient was apparently asymptomatic **4 months back** - Developed an **ulcer on the inner aspect of right cheek** - **Insidious onset**, **rapidly progressive** - Initial size: **1 × 1 cm** - Present size: **2 × 3 cm** - **Initially painless**, pain started since **last 2 months** - Associated with **loss of appetite** > What are the differential diagnosis of ulcer in Buccal mucosa? > What does Rapidly progressive VS Gradually progressive increase in size of buccal ulcer indicate? > What does late onset of pain in buccal cancer indicate? --- ### ❌ Relevant Negative History (with Clinical Significance) | Negative History Point | Clinical Significance | | --- | --- | | **No bleeding from lesion** | Suggests absence of surface necrosis, friable or highly vascular tumor | | **No difficulty in opening mouth (trismus)** | No involvement of muscles of mastication, masticator space, or temporomandibular joint | | **No history of trauma / sharp tooth** | Rules out traumatic ulcer as a cause | | **No halitosis** | Indicates minimal necrosis and absence of secondary anaerobic infection | | **No difficulty in chewing or speech** | Suggests buccinator, tongue, and masticator space are not involved | | **No excessive salivation / drooling** | Oral competence intact; no significant mucosal irritation or dysphagia | | **No recurrent ulcers / red or white patches** | No evidence of pre-existing premalignant lesion (leukoplakia / erythroplakia) | | **No loosening of teeth** | Suggests no alveolar process or mandibular bone invasion | | **No prior radiation exposure** | Excludes radiation-induced second primary malignancy | | **No difficulty in tongue protrusion** | Indicates tongue muscles, floor of mouth, and pterygomandibular space not involved | | **No dysphagia** | No posterior extension to retromolar trigone, oropharynx, or soft palate | | **No neck swelling** | Clinically node-negative neck (N0) | | **No weight loss** | Suggests early or localized disease; cachexia unlikely | | **No ear or nasal complaints** | No referred otalgia (V3 involvement) or nasopharyngeal extension | | **No cough, hemoptysis, breathlessness** | Lung metastasis unlikely | | **No bone pain, abdominal pain, jaundice** | No evidence of distant metastasis to bone or liver | > What is Trismus? What is it's clinical importance? > Name the muscles of mastication. > What are the sites of Distant metastasis in oral cavity cancer? What is the most common site amongst these? --- ### 🕰️ Past History - No previous surgeries - No drug allergies - No family history of malignancy --- ### 👤 Personal & Addiction History - **Decreased appetite** for last 3 months ### 🚬 Addiction History - **Bidi smoking:** 8/day for **40 years** - **Betel quid chewing:** 4/day for **45 years** - Keeps quid in **right gingivobuccal sulcus** > What are the carcinogens found in tobacco? > What is the mechanism of action of carcinogenesis by Tobacco? > What are the carcinogens found in quid contributing to oral cancer? --- ### 🦷 Local Examination (Oral Cavity) #### Inspection - **Single ulceroproliferative growth** - Size: **2 × 3 cm** - Site: **Right buccal mucosa** - Extent: - Anterior: 0.5 cm from oral commissure - Posterior: up to first molar - Superior: 3 cm from upper gingivobuccal sulcus - Inferior: 2 cm from lower gingivobuccal sulcus - **Averted (rolled) edges** - **Irregular margins** - **Floor covered with slough** #### Palpation - Tenderness present - **Induration extending 0.5 cm beyond visible margins** - Base: **firm, non-mobile** - **Not fixed to mandible** - Does **not bleed on touch** --- ### 🧠 Interpretation of Examination Findings ### Ulceroproliferative Growth - Indicates **squamous cell carcinoma** ### Everted / Rolled Edges - Due to peripheral tumor proliferation with central necrosis ### Induration - Hallmark of malignancy - Indicates **submucosal tumor spread** - Determines **true tumor extent and surgical margins** ### No Fixation to Mandible - Suggests **no bone invasion** - Rules out **T4 disease** > What is Edge of ulcer? What is Margin of ulcer? > What are the Types of Edges of Ulcer? What is the mechanism behind each one of them? Give examples of each type. > What is Floor of ulcer? What is Base of ulcer? > What is Induration? What is the Pathology behind Induration? What is it's clinical significance? --- ## 🆚 Benign vs Malignant Ulcer | Feature | Benign | Malignant | | --- | --- | --- | | Edges | Sloping | Rolled / everted | | Margins | Regular | Irregular | | Floor | Clean | Slough, necrotic | | Base | Soft, mobile | Hard, indurated | | Pain | Painful early | Painless early | | Bleeding | Rare | Common | | Induration | Absent | Present | > What are the Key Clinical Hallmarks of Malignant Ulcer? > What is Field Cancerization? What is it's Clinical Implications? > What is Synchronous VS Metachronous Tumors? What is Warren and Gates criteria? --- ### 📝 Case Summary - 65-year-old male - Chronic smoker and quid chewer - Rapidly progressive ulcer in right buccal mucosa - Ulceroproliferative lesion with: - Rolled edges - Induration - Slough-covered floor - No neck nodes --- ### 🩺 Provisional Diagnosis **Carcinoma of right buccal mucosa**, Clinical stage:** **T2N0MX (Stage II)** >What are the points in favour of your diagnosis? >What is the Differential Diagnosis of Buccal carcinoma? What are points in favour and against in each one of them? > What are the Anatomical Boundaries of Buccal Mucosa? > What is the most common site of oral cavity cancer worldwide? > What is the most common site of oral cavity cancer in India? > What is the TNM Staging of Oral Cavity cancer? > What is the difference between Premalignant lesions VS Premalignant disorders? Give examples of each. > What is Leukoplakia & Erythroplakia? Which has the highest malignant potential? > What is Oral Submucous fibrosis? What is the Pathophysiology of Oral Submucous fibrosis? --- ### 🏨 Management Plan Management always consists of two parts: Investigation and Treatment. #### 🔬 Investigations 1. **Incisional biopsy** - From **edge of ulcer** 2. **CECT / MRI** 3. **OPG** - If mandibular involvement suspected 4. **USG neck** - Occult nodes 5. **Chest X-ray / CT** - Lung metastasis 6. **PET-CT** - Advanced / recurrent disease > What is the purpose of doing CECT? > Which Lymph nodes get involved in buccal carcinoma? > What are the Features suggestive of Nodal malignancy on USG? > What is Broder’s Grading? --- **🩻 Treatment** 1️⃣ **Primary Tumor** - **Wide local excision** - **1 cm margin** - Depth up to buccinator / periosteum 2️⃣ **Reconstruction** - Local flaps (< 3 cm) - Free flaps (large defects) 3️⃣ **Neck** - **Elective supraomohyoid neck dissection** - Levels **I–III** - Due to 15–20% occult metastasis risk > What surgery is done when there is cortical or medullary invasion of mandible? > Name some local flaps and free flaps used in buccal carcinoma for reconstruction. > Classify Neck Dissection and define each one of them. > What are the different types of Selective Neck Dissection? > What are the Contraindications of Neck Dissection? > What are the Indications of Post op Adjuvant Radiotherapy? > What is Residual Tumor Classification? --- ## About This Note This note on Clinical Case Discussion: Buccal Carcinoma (Oral Cavity Cancer) is one of the free ENT study notes published by The ENT Resident. It is free to read on the website, and it is paired with a full video lecture on YouTube. This note is categorized under [Clinical Case Presentations](https://www.theentresident.com/ent-notes-lectures/category/clinical-case-presentations.md). The category page lists all the free ENT notes on that topic. Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/buccal-carcinoma-case-presentation When citing or referencing this content, please credit The ENT Resident and link to the canonical page above. ## About The ENT Resident The ENT Resident is a free library of ENT notes and video lectures created by Dr. Mausumi Das (MS ENT), the ENT doctor and educator behind The ENT Resident YouTube channel (https://www.youtube.com/c/TheENTResident). These notes are written for ENT residents, ENT postgraduates preparing for exams, and MBBS students, to help them learn ENT clearly and score well. 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Other contact options are on the contact page: https://www.theentresident.com/contact.md ## Related ENT Notes & Lectures #### Clinical Case Presentations - [Clinical Case Discussion: Antrochoanal Polyp](https://www.theentresident.com/ent-notes-lectures/antrochoanal-polyp-case-presentation.md) - [Clinical Case Discussion: Carcinoma Larynx (Glottic Carcinoma)](https://www.theentresident.com/ent-notes-lectures/carcinoma-larynx-case-presentation.md) - [Clinical Case Discussion: Chronic Suppurative Otitis Media (CSOM) - Atticoantral type](https://www.theentresident.com/ent-notes-lectures/atticoantral-csom-case-presentation.md) - [Clinical Case Discussion: Chronic Suppurative Otitis Media (CSOM) - Tubotympanic type](https://www.theentresident.com/ent-notes-lectures/tubotympanic-csom-case-presentation.md) - [Clinical Case Discussion: Deviated Nasal Septum (DNS)](https://www.theentresident.com/ent-notes-lectures/deviated-nasal-septum-dns-case-presentation.md) - [Clinical Case Discussion: Ethmoidal Polyp](https://www.theentresident.com/ent-notes-lectures/ethmoidal-polyp-case-presentation.md) - [Clinical Case Discussion: Solitary Thyroid Nodule](https://www.theentresident.com/ent-notes-lectures/solitary-thyroid-nodule-case-presentation.md) - [Clinical Case Discussion: Tonsillitis](https://www.theentresident.com/ent-notes-lectures/tonsillitis-case-presentation.md) --- Complete index of all pages on this site, with descriptions and markdown links: https://www.theentresident.com/llms.txt