Patient is 19 years old. History of chewing gutka heavily for 3 yrs but presently no Intake of tobacco. Lesion has developed in last two months .

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T4 aggressive tumour not surgeons hand do a biopsy to rule out atypical histology Go for chemo +RT

This is T4 tumor, composite stage will be minimum Stage IV, details of neck nodal examination is needed. Squamous cell carcinoma is the probable diagnosis, a punch biopsy will be confirmative. A CT scan is needed for assessment of operability, but the patient is having trismus which is an indication for inoperability. Neoadjuvant chemotherapy followed by surgical assessment can be tried otherwise palliative Radiotherapy.

I agree that pt needs palliative t/ t but trismus is not cause of inoperatability palliative CT &radiotherapy can be tried immediately as pt is young so aggressive m/ m can be done.later on may think of limited resection depending on response.

squamous cell carcinoma..refer oncology specialist..biopsy

cect to rule out gross high ITF involvement ...if negative then 2 cycles NACT and then reasses

SCC...need a team of oncology surgeon, maxillofacial surgeon and ent specialist......

Scc...??? Refer to oncology

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