A 58-year-old patient came into the office complaining of sinus congestion with sinus pressure, sore throat, and postnasal drip that had been getting progressively worse over the past week. He had tried over-the-counter decongestants, but his symptoms were not resolving. He told the physician’s assistant (DR) that he’d had sinus infections in the past and that he thought he had one now.
When asked about his general health, the patient indicated that he vaguely remembered being told years ago that his cholesterol was elevated, but at the time, declined any medical treatment. He indicated that he hadn’t had a physical examination in years. He said that he only went to the doctor when he was “sick.”
The patient was a cigarette smoker and had smoked a pack a day for 35 years. He said that while he smoked mostly cigarettes, he would also have an occasional cigar. He said that he had never smoked tobacco through a pipe. He also indicated that he drank 3 to 4 beers daily.
While inspecting his pharynx during the physical examination, DR noted a lesion on the posterior hard palate that extended to the soft palate (FIGURE 1). It appeared macular and erythematous, and had an eroded surface. The borders of the lesion were diffuse and irregular, measuring approximately 2 cm Ø 3 cm. During palpation, the lesion was mildly painful, but there was no firmness along the soft palate, buccal mucosa, or tongue. The patient had poor oral hygiene, multiple missing and carious teeth, and a removable partial denture. All other mucosal surfaces were within normal limits.
As the patient suspected, he did have a sinus infection. He left the office with a prescription for an antibiotic. He also left with a referral to an oral maxillofacial surgeon for further evaluation of the lesion.
FIGURE 1
Lesion on the hard palate
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