Failed Diagnosis of Oral Squamous Cell Carcinoma

This case takes place in Wisconsin and involves a male patient who was diagnosed with stage IV B squamous cell carcinoma of the oral cavity. He has a social history which includes smoking and occasional alcohol use. He initially presented to his dentist with pain in his jaw. His dentist referred him for testing to the defendant doctor. Neoplasm was on the defendant’s differential, but he ultimately elected to remove the patient’s submandibular salivary gland. Pathology was benign. The patient reported that his pain had decreased post-operatively, but he developed an inability to open his jaw. The defendant referred the patient to physical therapy, which provided no improvement in his condition. Ultimately, the patient presented to a major medical center a year later. An examination revealed a soft tissue swelling. A CT scan revealed a mass measuring 3 x 3.5 x 3.5 cm. A subsequent biopsy revealed squamous cell carcinoma.

Question(s) For Expert Witness

1. How often do you treat patients with these presenting complaints?

2. Based on this brief summary, do you believe that the standard of care required referral to oncology for further work-up including PET scan, to rule-in or rule-out malignancy?

Expert Witness Response

I regularly work with patients with a similar presentation to that described in this case. The problem in this case appears to be the biopsy. The question in this case is why a biopsy was not performed considering the presenting symptoms. After a tissue diagnosis, referral would be in order. This is a classic failure to diagnose. Based on this brief summary, I believe that care could have been rendered differently. I would need more information to fully speak to the diagnosis and further work-up.