Surgical treatment of advanced oral cancer for patients with mental retardation : A case study

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  • 精神発達遅滞を有する進行口腔がん患者への外科治療経験

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Abstract

Oral cancer patients with mental retardation have specific needs due to their mental condition. Conservative treatment consisting mainly of radiation therapy is often selected because of difficulties in explaining and obtaining consent, perioperative management, postoperative rehabilitation, and support upon discharge. For these reasons there are few reports on surgical treatment. Reported here is an outline of treatment in which favorable results were obtained when surgical treatment was performed on an advanced oral cancer patient with mental retardation. The patient was a 46-year-old female who was referred to our department when swelling in the right soft palate was discovered at a nearby dental clinic. Medical history showed mental retardation with a mental age equivalent of a 9-year-old child. Background information showed the entire family had mental retardation. Intraoral findings indicated the formation of an elastic slightly hard mass centered in the right soft palate and extending to the hard palate, left soft palate, and pharynx. Because imaging findings were suspicious for malignancy a biopsy was performed and a pathological diagnosis of mucoepidermoid carcinoma was obtained. After repeated discussions with the patient and her family, with the aid of the Livelihood Support Center staff, a surgical curative treatment was chosen. Right total neck dissection and tumor resection (right subtotal maxillectomy) with oral reconstruction by rectus abdominis muscle flap was performed under general anesthesia. The patient is currently under observation at 2 years and 3 months after surgery and there are no signs of local recurrence or distant metastasis of the malignancy.

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