Cancer of the oral cavity and medical malpractice

OBJECTIVE: To analyze malpractice litigation initiated by patients with cancer of the oral cavity as a result of allegations concerning their diagnosis and treatment. STUDY DESIGN: Retrospective review. METHODS: Jury verdict reviews from 1984 to 2000 were obtained from a computerized legal database and analyzed. Reviews compile pertinent data on defendants, plaintiffs, verdict outcomes, indemnity payments, and allegations of wrongdoing and provide case summaries. Fifty cases from 21 of all 50 states were obtained. Data were entered into a spreadsheet for analysis. RESULTS: Overall, a young age (mean age, 45 y) and poor oncological outcome (47% dead) were seen. The younger age group (<47 y) had a better outcome (65% without disease), were more often misdiagnosed (19%), won awards (60%), and had higher awards (average award, $755,824) as compared with those older than 47 years of age, who had 39% without disease, 0% misdiagnosed, and 52% who won awards that were less, on average, at $495,417. Failure to diagnose the cancer was alleged, overall, in 43 of 50 cases (86%), and in general practice, dentists, and otolaryngologist in 100%, 85%, and 89%, respectively. Suits alleging a delay in diagnosis of less than 3 months were defendant verdicts in 86%, and of more than 3 months, in 40%. Failures to perform biopsy and to refer were common allegations. CONCLUSIONS: Young age of patients bringing litigation is seen in patients with oral cancer. These patients frequently have poor oncological outcomes. Risk management goals to prevent delays in diagnosis may help prevent subsequent litigation.     

Histoplasmosis of the oral cavity

Histoplasmosis is an endemic mycosis. Histoplasma capsulatum, and duboisi? are the pathogenic agents in humans. The disease is reported as endemic in more than 30 countries. Three clinical forms are distinguished; acute, chronic and disseminated. Oral lesions may take on different clinical aspects which are often associated with disseminated histoplasmosis. Disseminated histoplasmosis is frequently diagnosed in immunocompromised hosts. High risk of mortality dictates rapid diagnosis and treatment.     

Pain from the oral cavity

The head, face, mouth, and throat collectively is the most frequent site of pain in humans. Facial pain is a particularly distressing problem because identification and effective treatment of the underlying cause is often challenging and sometimes elusive. This article focuses on the more common causes of facial pain that originate in the oral cavity and associated structures and outlines a general approach to diagnosis and management of these problems.     

Use of the laser in the oral cavity

Laser surgery is now commonly performed for lesions arising in the oral cavity. The laser provides certain advantages relating to the precision of tissue destruction and some hemostatic capabilities. However, it is the author's impression that it provides no special healing or cancer-killing advantages. It can be used for a wide variety of surgical procedures involving benign lesions. Its use for resection of oral cavity malignancies is restricted to verrucous cancers and smaller cancers. When the proper techniques are used to protect both the patient and the surgeon and other operating room personnel, it can be a safely performed surgical adjunct that has certain advantages over standard surgical approaches.     

Verrucous carcinoma of the oral cavity

The clinical course and morphologic (light and ultrastructural) characteristics of a case of verrucous carcinoma of the lower gingival mucosa are presented. Clinical course of the patient was unfavorable following surgery (supposedly incomplete) and radiotherapy (6,000 R) of the tumor. The therapeutic factors that may influence an unfavourable prognosis are commented upon, especially in regard to a slow-growing neoplasm with a generally good course.     

Osteomyocutaneous reconstruction of the oral cavity

Osteomyocutaneous reconstruction of the anterior oral cavity affords rapid rehabilitation that saves the patient hospital time and substantial expense when compared with secondary reconstruction techniques. When successful, it offers more rapid and complete rehabilitation of the oral cavity because of the immediate and permanent maintenance of intraoral relationships without cicatrix. Four patients have successfully undergone reconstruction with this flap. Comparison of hospital records have shown that this operation, when successful, can save 24 to 47 days in the hospital over a period of one to two years in comparison with patients who must have secondary reconstruction substituted for the primary flap. The difference in hospital bills can be as much as $26,000 to $39,000 per patient.     

Nonsquamous tumors of the oral cavity

The clinical presentations of various nonsquamous tumors of the oral cavity are reviewed, along with their gross pathology, histology, and treatment. Survival rates are presented for those neoplasms that occur frequently enough to allow meaningful analysis of various modes of therapy.     

Giant fibrolipoma of the oral cavity

Firbolipomas are rat e tumors of oral cavity Here, we present a case of giant fibrolipoma of the oral cavity