The patient, a woman in her mid-sixties, was evaluated by a general dentist in May for a large yellow spot on the left side of her tongue. The dentist attributed the lesion to biting her tongue. He rendered no treatment and wrote a note to check the lesion again at the patient’s next visit.
In March of the next year, the patient presented to the dentist with a yellow and white patch on the left posterior side of the tongue and the tip of the tongue. The dentist referred the patient to the defendant oral surgeon. The defendant saw the patient in the beginning of April, at which time he noted the patient’s past medical history as a cigarette smoker and prescribed triamcinolone acetonide dental paste. In a letter to the patient’s dentist, the defendant recommended that the lesion be observed at her regular cleaning appointments and advised that if it became much larger, he would recommend removing it in the hospital. Defendant neither biopsied the lesion nor scheduled a follow-up appointment.
The next March, the patient called the defendant and reported that she was in extreme pain and that the sore was eating away her tongue. The defendant called another prescription in for her for triamcinolone acetonide dental paste. The patient called again in May, and the defendant consented to see her. He examined the patient, noting that the lesion had become larger, and referred her to an otolaryngologist (ENT). However, the defendant did not indicate in the referral that it was urgent, so the ENT advised that he did not have any availability to see the patient until June.
Concerned, the patient’s husband contacted another ENT, who was able to see the patient immediately. A biopsy of the patient’s tongue was performed, and a CT/PET scan of the neck was also performed. The ENT’s impression was that the patient had an ulcerative mass on the left side of her tongue, which was suspicious for squamous cell carcinoma. The next week, the cancer diagnosis was confirmed.
The patient underwent surgery a week later for a left hemiglossectomy with left partial neck dissection. The patient returned to the hospital the next day for surgery to control significant postoperative bleeding from the tongue. The patient began a course of radiation treatment but became dehydrated and suffered radiation burns for which she had to be hospitalized.
By February of the next year, the radiation proved unsuccessful. The patient underwent an aspiration of a right neck mass, which revealed that the cancer had metastasized to the lymph nodes on the right side of her neck. She resumed treatment but gradually weakened and endured great pain before her death in October.
The patient’s husband filed a lawsuit which named the defendant oral surgeon. The plaintiff’s oral surgeon expert opined that the defendant should have biopsied the lesion when he first saw the patient, over a year before he referred her to an ENT.
The jury awarded the plaintiff over $1 million, apportioning fault at 40% plaintiff and 60% defendant oral surgeon.
With permission from Medical Malpractice Verdicts, Settlements & Experts; Lewis Laska, Editor, 901 Church St., Nashville, TN 37203-3411, 1-800-298-6288.