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Dr. Hasan
Dr. Hasan, Doctor
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Experience:  MBBS, FCPS, with experience in all fields of medicine and surgery
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Are there any doctors on here that are ENTs?

Customer Question

Are there any doctors on here that are ENT's?
Submitted: 10 months ago.
Category: Medical
Expert:  Dr. David replied 10 months ago.
Hello, this is Dr. David. I have read your question and I'm ready to help.

what ENT question do you have?
Expert:  Dr. Hasan replied 10 months ago.
HI, Thanks for your question. My name isXXXXX and I am here to help you today. I will be happy to help you with your follow-up questions also. I am an ENT specialist. How can i help you? Regards
Customer: replied 10 months ago.

Hi,


Thanks for your reply. Just for health history. I had a bone marrow transplant due to CML (leukemia) in 1994. I am not on any immunosupressant drugs and may have been only initially after transplant.


 


I'm 38/female. In Feb 2013, I coughed up a papilloma. I took it for pathology. It was found as benign squamous epithelial papilloma. I'm posting a photo of the one I coughed up.


 


Then in June 2013, I found a papilloma growing off the front left side of my uvula. I had it removed in the ENT office and he sent it for pathology. It came back as moderate dysplasia (also called high grade) with hpv cellular changes.


 


Now, last week, the ENT did a flexible larynoscopy through my nose in his office. He saw another papilloma again on my uvula except this time on the back left side of uvula. He said it does not "look cancerous" and that it's small. I want this thing out ASAP so I'm scheduled for outpatient surgery next week.


 


My questions are, I can't seem to find much info. about these growths other than related to RRP. Maybe this is the beginning of adult onset RRP. I find info. about oral papillomas and most everything says they are usually benign and rarely cancerous. Is my situation so unheard of? Have you seen this before? I'm very scared about this. Any info. you can provide is greatly appreciated.


 


Thank you.


Lana


 


 


 

Customer: replied 10 months ago.

Here's the photo of the one I coughed up that pathology said was benign squamous epithelium. I had the sensation of something stuck in my throat for several months but thought I was imaging it until I coughed this up. I'm not sure if this was on my uvula as well or if it was on vocal cords.


 


Expert:  Dr. Hasan replied 10 months ago.
Lana thanks a lot for your question. Do you have any symptoms like nasal regurgitation of food or fluid through nose, nasal bleeding, nasal obstruction, ear blockade, hoarseness of voice etc? Regards
Customer: replied 10 months ago.

Hi,


Hmmm.....no I don't think so. What I do have is running nose that seems to have gotten better within the last couple days. The ENT said he saw a lot of mucus but it was clear in color. When my nose was runny and full of mucus, my ears felt clogged (like water in the ear) but no pain. During this time I would cough up yellowish colored phlegm once or twice per day. Just in the last couple days this has gotten somewhat better. I'd clear my throat some during the day because of the phlegm but I can't say I've really noticed hoarseness.

Customer: replied 10 months ago.

Wouldn't the flexible larynoscopy I had in the office find the cause of the symptoms you describe above?

Expert:  Dr. Hasan replied 10 months ago.
Thanks a lot for your input. I will keep trying your concerns separately and you can keep asking more. Yes this can be RRP. Although it is common in children but we see it in adults too. You have very rightly suspected that and yes this can be your cause. You had HPV changes in histopatholoy once and that makes RRP of adults more likely in your case. The point is this that should you be stressed about these papilloma. The answer is NO not at all because they are almost always benign rather i would say that are always benign. The symptoms which i asked for are not present in your case so this again mean that no cancer is likely to be there. What you have with your ears and nose is actually allergy related and you should ask your doctor to prescribe steroid nasal spray for that. Go ahead with the biopsy of the lesion and if your doctor agree that it is RRP then ask for some treatment like Indole 3 carbinol or there are many other agents which have been found to be useful for RRP. Yes flexible laryngoscopy does find most of the causes. Lastly i have a home remedy for your nasal mucus. Take 250 ml of honey, add one table spoon each of ginger extract and black pepper. Make a solution and take one teaspoon twice daily. It might take 15 days or more but will help you. All the best for your surgery, I wish you good luck that you get well soon, please ask if you have any question because our discussion always remains open so you can always ask more till you are satisfied, You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to help you always.
Dr. Hasan, Doctor
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Experience: MBBS, FCPS, with experience in all fields of medicine and surgery
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Customer: replied 10 months ago.

Hi,


Thanks so much for the home remedy. I will try this. I've never had allergies and live in Georgia where pollen can be horrible. But I've heard allergies can develop suddenly.


 


Have you ever seen or heard of a dysplastic papilloma or seen one in your practice? Do papillomas of the uvula tend to spread to the vocal cords as well? Doesn't dysplasia (especially moderate as was my growth) usually turn to cancer if untreated?


 


I feel like I have some rare disease that I will eventually succumb to. I guess this is due to my history with bone marrow transplant and I know this makes me more susceptible to solid cancers.


 


When I looked up laryngeal papillomas I was able to find information about RRP turning into cancerous lesions.


 


If I were your patient, would you recommend aggressive monitoring and is dysplasia not concerning in a papilloma?

Expert:  Dr. Hasan replied 10 months ago.
You are most welcome. RRP is not same as the cancer caused by HPV. RRP can lead to throat cancers. Most HPV-related throat cancers are caused by oncongenic variants of the virus, but RRP is caused by HPV-6 or HPV-11. These two types of HPV generally only cause benign papilloma to risk of cancer is very low. Yes i have seen dysplastic pappiloma but so far never seen it converting into cancer, that doesn't mean that it can't but i have never seen in my practice because it's not common for it to convert into or cause cancer. Anti viral treatment for it can reduce the chances of conversion to cancer but leaving it untreated doesn't mean that it is going to become cancer always. papillomas of the uvula very rarely tend to spread to the vocal cords, mostly they don't. If you were my patient definitely i would have advised you to have regular follow up but would have advised you not to stress yourself and that i am advising now too :), please ask if you have any question because our discussion always remains open so you can always ask more till you are satisfied, You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to help you always.
Dr. Hasan, Doctor
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Customer: replied 10 months ago.

Thanks so much for your help and all the information and patience in answering my questions and your kindness. I may come back to you in the future with additional questions.

Expert:  Dr. Hasan replied 10 months ago.
You are most welcome. I will be glad to assist you any day any time :) Regards
Dr. Hasan, Doctor
Category: Medical
Satisfied Customers: 7174
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Customer: replied 10 months ago.
Hi,
I would like to ask you a couple follow up questions please. I had surgery this past Tuesday. It was a 20 minute surgery and went smoothly. My ENT surgeon told my husband he looked with the direct laryngoscopy and did not find any other abnormal findings. He removed the small papilloma on the back of my uvula. I've never had oral surgery other than wisdom teeth removal and I find this uvula surgery somewhat gross. Please tell me if these things are normal:

Wednesday my uvula was black And looked almost like necrosis to me. Thursday and today it's got this disgusting white film around it. It reminds me of a cocoon. It's somewhat uncomfortable to eat. Is this typical??

Yesterday (Thursday) I noticed this strange sensation on the underside of my tongue on left side. The best way to describe is imagine if there were a single hair wrapped around part of your tongue. When I look in that area, the underside of my tongue on that side almost looks swollen.

And the last thing, I have an appointment to go back to my ENT in two weeks. IF by chance the pathology of the papilloma came back cancerous, would the doctors office typically call me before my two week appointment? I know you can't answer for my doctors office but I'm just asking in general terms?

Thanks !
Svet
Expert:  Dr. Hasan replied 10 months ago.
Hi, I am sorry to hear about your problem. Yes the black looking uvula was due to collection of blood in it after surgery and white film is basically slough that forms during healing. The tongue swelling or feeling of something stuck in the throat can be because of the tube (if it was put for anaesthesia) or can be due to some minor trauma during surgery. Generally speaking yes they might call you before 2 weeks in that case but as you know this depends on your doctor. I wish you all the best and pray that your results may come back negative for any cancer. Please ask if you have any question because our discussion always remains open so you can always ask more till you are satisfied, You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to help you always.
Dr. Hasan, Doctor
Category: Medical
Satisfied Customers: 7174
Experience: MBBS, FCPS, with experience in all fields of medicine and surgery
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Customer: replied 10 months ago.

Hi,


If I could please ask a couple follow up questions?


 


 


1. 3/4 of my uvula turned white and fell off. Is this typical for something like this to occur?


 


 


2. Surgery on my uvula was this past Tuesday. Thursday I felt like I had a "hair" on my tongue. I quickly realized there was nothing there. It's on the underside left side. It's almost like a numb feeling and it's extra sensitive. I don't see anything there other than this lumpy looking area I circled and included a photo. When I touch that bumpy area, it just feels like normal tongue. Another words, it does not feel like a hard lump or anything. Does this look like something abnormal or can one underside area of the tongue be "lumpier" than the other? I don't know that I've ever noticed this before so I can't say if it was there before.


 


I'm posting the photo next.


 


Thanks!


 

Customer: replied 10 months ago.

Expert:  Dr. Hasan replied 10 months ago.
Thanks a lot for your input. First of all as far as your uvula is concerned, you are doing because its normal for the necrotic part to slough off. So don't worry it will regenerate very soon. As far as your lumpy tongue feeling is concerned, I have reviewed the picture, I really can't give any diagnosis about the cause but there is one thing u can assure you that since the overlying skin/mucosa is perfectly normal you should forget about having anything serious like cancer. It might be normal and might be you have just noticed it. Your ENT can determine this but nothing at all to worry. All the best for a good recovery. Regards
Dr. Hasan, Doctor
Category: Medical
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Customer: replied 10 months ago.

Hi,


When you say the "overlying skin/mucosa is perfectly normal", does that mean it looks normal from the photo I posted OR because of my description that it feels like normal tongue tissue?


 


And also, you are saying the 3/4 of my uvula that broke off will regrow?


 


Thanks!

Expert:  Dr. Hasan replied 10 months ago.
Hi, I am saying so about overlying skin because I have reviewed your pic after zooming.
Yes uvula will not take its original shape but ultimately the tissue gap will fill significantly. Time will tell what happens exactly in your case because healing varies. Can you send me the pic of your uvula. Regards
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Customer: replied 10 months ago.

Hi,


Yes, here's the photo. I just took it. I know it looks like I have a uvula but it used to be 3/4 more than what's there now. You can see there's still a white area but the area that fell off had gotten longer and longer until it was like a big white bulb that was gagging me. Also, along the edge where I attempted to circle with my paint tool, it's bright red and raw looking there. Hard to see that in this photo.


 

Customer: replied 10 months ago.

Expert:  Dr. Hasan replied 10 months ago.
Excellent pic. Your main uvula seems intact, it's just the area to the side of uvula and yes it will heal perfectly. Even if a small defect is left, there is nothing to worry because it will not effect you functionally in any way . Just relax and enjoy your life. Regards
Dr. Hasan, Doctor
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Customer: replied 10 months ago.

Thanks doctor!

Expert:  Dr. Hasan replied 10 months ago.
I guess you must be relieved yourself after seeing your uvula.
Customer: replied 10 months ago.

It was strange to have a part of my mouth fall off and swallow it while sleeping. I am a little relieved, just concerned about the biopsy results of the papilloma on the back of the uvula and the bumpy underside of tongue but will hope that all is normal. Thank you for your patience and help.

Expert:  Dr. Hasan replied 10 months ago.
You are most welcome. Oral cavity heals like a magic many a times. Quick healing itself means the area operated was healthy otherwise it might not have healed that quickly. Good luck and I will be waiting for your results and will be praying too that everything comes back ok. Regards.
Dr. Hasan, Doctor
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Customer: replied 10 months ago.

Thank you so very much Smile. I will let you know once I find out.

Expert:  Dr. Hasan replied 10 months ago.
Sure I will wait.
Dr. Hasan, Doctor
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Customer: replied 10 months ago.

Hi Dr. Hasan,


I received my uvula papilloma biopsy results. This growth was benign (no dysplasia). I was of course very happy about this.


Another question please, I had some mild pain in my throat on the left side and the doctor took a look and said it looked like an ulcer. I've never in my life that I remember had an ulcer in my throat. Are these things typically benign, can a doctor tell the difference between an ulcer and some other type of growth? I've heard before that ulcers can be a sign of mouth or throat cancer depending on where the ulcer is located of course.


Thanks again for your help.

Expert:  Dr. Hasan replied 10 months ago.
Hi, I am sorry for the delay. First of all congratulations for your biopsy result. Yes throat cancer can present with ulcer in the throat but doctor can tell by looking that ulcer is cancerous or not. ENT doctor can many a times differentiate it. In your case if you have got that pain recently then there is no reason to suspect cancer. Cancerous ulcer have a long history and with a short history of painful ulcer i never suspect cancer. In your case either the ulcer is likely to have developed due to low immunity after operation. I really suggest you to forget cancer at this stage. I wish you good luck that you get well soon, please ask if you have any question because our discussion always remains open so you can always ask more till you are satisfied, You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to help you always.
Dr. Hasan, Doctor
Category: Medical
Satisfied Customers: 7174
Experience: MBBS, FCPS, with experience in all fields of medicine and surgery
Dr. Hasan and 8 other Medical Specialists are ready to help you
Customer: replied 10 months ago.
It's my prior history in 1994 with chronic mylogenous leukemia and bone marrow transplant I think that has me constantly worried about cancer. Along with the 7 month history now of 3 papillomas, one of which had the moderate dysplasia with HPV cellular changes, I guess I'm convinced throat or mouth cancer will eventually be my next battle.
As far as the ulcer goes in the throat, when I went for my two week post op visit this past Tuesday, there was no ulcer. This was with the ENT that did my surgery. He did another flexible endoscopy too so he checked again and wanted to see how the back of the uvula was healing. So the ulcer was not there 3 days ago. So yesterday the ENT was one near my house ive been to before. He was also the one that cut off the second papilloma in his office that ended up being the dysplastic one. He looked with mirror and said ulcer. Prescribed MAgic mouth wash and said come back in 6-8 weeks. I'd hope if suspected something sinister, he would have biopsied it. As a side note, Thursday afternoon I did drink some scalding hot tea not realizing how how hot it was. Maybe that's the reason for the ulcer. It makes me feel better that you are saying a lot of times ENT can tell if something does not look right with ulcer .
Customer: replied 10 months ago.
If I may ask, since part of my uvula became necrotic after surgery and fell off after growth was removed from the back of uvula.....does this say something negative about the skill of the doctor?
Expert:  Dr. Hasan replied 10 months ago.
Yes i understand your concerns but it's not so actually. I have seen many patients with moderate dysplasia with HPV cellular changes that has never progressed to cancer. So short history of ulcer means that it can't be cancer. Yes burn from tea can quite frequently cause this. Yes cancerous ulcers have a different appearance. At least i can give you my words, just from history that you cant have cancer in that ulcer :). The necrosis and falling of a pat of uvula was not related to your surgeon's skill, it was part of healing process. Regards
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Customer: replied 10 months ago.

Thank you!!!

Expert:  Dr. Hasan replied 10 months ago.
Most welcome my dear :)
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Customer: replied 8 months ago.

Hi Dr. Hasan,


Well it's been 2 months since my uvula surgery. Today I found on the inside of my cheek, the attached. I tried to take a picture of it and circled it with a draw tool in the photo. This looks to me just like erythroplakia. When I run my finger over this red area, it does not feel any different than my regular skin tissue. I have become somewhat obsessed with my mouth because of the now 3 papillomas I've had over the last 10 months. I look in my mouth with a flashlight 3 times per day (yes I know this sounds crazy) and this red area was not there yesterday. Do you think this looks sinister? It actually looks worse in the photo than in person because of the flash on my camera.


Expert:  Dr. Hasan replied 8 months ago.
Hi, can you guess that since how long approximately you have this? Are there any white dots in this red area? Regards
Customer: replied 8 months ago.

Hi,


I think it appeared today, it was not there yesterday. No white dots around the area.

Expert:  Dr. Hasan replied 8 months ago.
Thanks a lot for your input. I am so sorry to hear about your problem and can understand that you must be very stressed but I assure you that this can't be pre cancer (erythroleukoplakia) or leukoplakia or any cancer because;
1. No pre cancer or cancer can appear overnight.
2. It's look is consistent with dental trauma or can be food burn or aphthous ulcer.
So just don't stress yourself and enjoy your life. It will get better in few days. Canker sore paste and few other similar products are available over the counter, specially at Walgreens. Use it twice daily along with Tylenol and hopefully you will feel relief. All the best dear :)
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Customer: replied 8 months ago.
Thanks so much. It looks so similar to erythroplakia picture I saw online, almost exact. Although there are no white spots around the area, I do get what look like tiny canker sores on the inside of my cheeks on a weekly basis. They cause no pain and sometimes appear and disappear within a matter of hours. I will keep an eye on this red area and I do hope it will go away. Thank you as always for your kindness and patience.
Svet
Expert:  Dr. Hasan replied 8 months ago.
You are most welcome. Seeing things online is the biggest source of stress. The main point here which I know from experience is this that no precancer or cancer can develop overnight. I assure you it's not erythroleukoplakia. Many lesions look similar in the beginning. 100% guarantee :) do you have burning sensation there?
Customer: replied 8 months ago.


Hi,


No burning sensation at all. I wouldn't even know it was there, I only saw it because I examine my mouth daily.

Expert:  Dr. Hasan replied 8 months ago.
Thanks for your input. If there is no burning sensation then this again makes erythroleukoplakia not likely. So don't stress yourself at all. Regards
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Customer: replied 8 months ago.

Hello Dr. Hasan,


If I may please ask one more question. Today I went for my two month check up (surgery back in September to remove the papilloma on the back of my uvula). The doctor that did the surgery examined me today with the fiber optic scope. He said everything looks good so far. He did mention if I remember correctly, adenoid hyperplasia I believe is what he said. He was unconcerned about it and said it's from the silent reflux I have as evidenced by I guess by the look of my throat. He told me to come back in 3 months and said my exam was fine. Isn't hyperplasia a precursor to cancer??? Is this a concerning finding?

Expert:  Dr. Hasan replied 8 months ago.
Hi, I am glad to know that every thing went well for you. Yes adenoid hyperplasia although not common at your age but yes it is possible and not common at all, so just don't worry. I have seen many patients like this and cancer has never been found in such cases. If I am not wrong you snore? Isn't it? If can be one of the major causes for your snoring if it is large enough but usually it's not that big in adults. Regards
Customer: replied 8 months ago.

Hi,


I think I do snore yes.
You say, "although not common at your age but yes it is possible and not common at all".


Do you mean not uncommon?


 


 

Expert:  Dr. Hasan replied 8 months ago.
Hi, so sorry for typo. Yes I meant that it's not common but still possible. Regards
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Customer: replied 7 months ago.

Hi again and happy holidays. I went to the ENT for my every two month check at the end of November. Everything was fine and no new papillomas. I seem to frequently get these little growths on the insides of my cheeks around the linea alba. They almost look like little painless ulcers and are usually gone within 24 - 48 hours. Today I noticed one along the other side of my inside cheek, also seems to be around the linea alba but this one is a little more yellowish in color and is protruding moreso than what I've seen in the past. I started thinking, perhaps this is another papilloma. It is very small but I'm wondering if this is the beginning of another papilloma. Have you seen anything like this before? I'm going to post a photo and I have circled the area.

Customer: replied 7 months ago.

Customer: replied 7 months ago.
One more thing, I'm wondering if this could be a salivary stone as it does have a yellowish color and looks very similar to some photos I've seen online of salivary duct stones....just a thought. Thanks again
Expert:  Dr. Hasan replied 7 months ago.
Hi, thanks a lot for your input. I am so sorry to hear about this lesion. Picture is not so good but yes it can be a papilloma in early stage. Salivary gland stone is not likely because the site where it is not consistent with salivary stones. If it is not painful then it can't be an ulcer and it's look is also not like ulcer. It can be a minor salivary gland cyst which is also yellowish in color and can occur anywhere in mouth. Along this line cheek bites can also cause such lesions but I think it's less likely because the the lesion in your case is slightly behind that area where teeth occlude. But there is no chance for this to be any serious lesion like cancer because look is Just of a benign lesion. So don't worry :) and happy holidays to you. Regards
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Customer: replied 7 months ago.

Hi


Thanks for the reply. If I may ask one more question please. This morning the yellowish growth looked slightly bigger. Using my finger nail, I rubbed the end slightly and it came off immediately. Here's a picture of what the area looks like now. If this were a papilloma, I would think it would not have come off so easily. I'm still thinking perhaps it was a salivary gland stone?


 

Customer: replied 7 months ago.

Expert:  Dr. Hasan replied 7 months ago.
Thanks a lot for getting back to me. Yes of course it can't be a papilloma if it has just gone away like this. The only thing possible this way is salivary gland cyst. Stone is even less likely because stone doesn't come out like this by scratching. So it was a cyst in my opinion. So congrats, it has not stressed you much :) Regards
Customer: replied 7 months ago.

For example, IF it were a papilloma, would using my fingernail tip the way I did have caused the papilloma to break off? I wasn't really that aggressive with it my fingernail before the growth came off.


 


 


 


 

Customer: replied 7 months ago.

I mean to say I was not really that aggressive with my fingernail against the growth before it came off. Also, the way the circled area in the second picture looks is what I commonly seem to get along that linea alba line, where it slightly protrudes out and then it's usually gone within 2 days and then I get another one maybe 3 days later along that same area. Seems to happen way more on the left side although this pic is from the right side. Today the left side has nothing on it.

Expert:  Dr. Hasan replied 7 months ago.
Papilloma can never get scratched with a finger nail because it is a structure with deep roots so if you have pulled it with a gentle scratch, just forget that it was pappiloma. Just relax and there is no need to stress yourself. Along this line you can get salivary gland cysts. Next time if you get this, send me a better picture. Regards
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Customer: replied 7 months ago.

Thank you.

Expert:  Dr. Hasan replied 7 months ago.
You are always welcome. My best wishes and prayers are for you always. Regards
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Customer: replied 7 months ago.

To you as well.

Expert:  Dr. Hasan replied 7 months ago.
Thanks a lot :)
Dr. Hasan, Doctor
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Customer: replied 7 months ago.

Hi Dr. Hasan. Sorry to contact you again so soon. Now I am really nervous. It seems that little thing is starting to regrow. This is very alarming......what would regrow so quickly?

Expert:  Dr. Hasan replied 7 months ago.
It's ok you can contact me as many times as you want. Can you send me a good pic of it? Regards
Customer: replied 7 months ago.
I wish I could take a photo of it but my husband takes the photo and he is sleeping. I have to hold my mouth open and use the other hand to hold the flashlight. I can have him help me tomorrow and take another picture. However it pretty much looks like the second photo I sent you after the majority of it came off except just a little more protrusion, it just has grown back a little bit.

Does this put papillomas back as possibility or maybe something cancerous/aggressive type of dangerous growth?
Expert:  Dr. Hasan replied 7 months ago.
Thanks a lot for your input. It's ok no problem. No it's not like what you are thinking, probably what you are feeling can be the scab or healing tissue which was supposed to grow after your scratch yesterday. Neither papilloma nor cancer can be so much aggressive to grow overnight. Even aggressive tumors take weeks to months to grow slightly in size. I give you my words for that so don't worry at all. Regards
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Customer: replied 7 months ago.
IF it is really truly growing back, would you think it's still a salivary cyst or maybe skin tag?

I will see what it looks like tomorrow, I think I'll know then for sure if its truly growing back and will have my husband take a better picture with a better camera and will post it on here to you.

If tomorrow I see real growth, based on your opinion, do you still think salivary gland cyst?

Thank you doctor.
Expert:  Dr. Hasan replied 7 months ago.
I will still not think about papilloma Or cancer. I have a strong feeling that it's a scab or tissue response to the scratch. Papilloma and even aggressive cancers can't grow over night. So just relax. Regards
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Customer: replied 7 months ago.
Thank you again.
Expert:  Dr. Hasan replied 7 months ago.
You're always welcome.
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Customer: replied 7 months ago.

Hi Dr. Hasan,


Here is another photo with a different camera. It's still difficult to see the little area clearly. Is this photo any better to take a look at it? I don't really think it's bigger but it's still there. The little piece I knocked off has not grown back.


Customer: replied 7 months ago.

Sorry, I realized the photo was too large. I've resized it and here it is again.


 


Expert:  Dr. Hasan replied 7 months ago.
Thanks a lot for your input. Well this is good picture. It resembles to some extent with papilloma but can't be sure because direct examination is something else. At your convenience see an ENT but i can assure you with 100% guarantee that it is not cancer of any form. It is just a benign growth. Regards
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Customer: replied 7 months ago.

Thanks for your response and for taking a look at another picture. I'm not sure what happened but in approximately 8 - 10 hours, whatever this was on my cheek is now almost gone. Strange because I was convinced it was the beginning of a very small papilloma. It could not be that if it went away that quickly. Anyways, I am very happy about. Each papilloma (I've had 3) has appeared a little over 3 months of each other. Papilloma #1 end Feb 2013, #2 mid June 2013, papilloma #3 mid September 2013. This is around the time I'd expect #4 if the pattern was consistent.


Thank you again.

Expert:  Dr. Hasan replied 7 months ago.
You are most Welcome . I am myself feeling do glad that you have got rid of it. If it has gone so quickly then we must consider the diagnosis of minor salivary gland cyst. All the best and congratulations. Regards
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Customer: replied 7 months ago.
Thank you and again thank you for your kindness and patience.
Expert:  Dr. Hasan replied 7 months ago.
You are always welcome , any day any time :) regards
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Customer: replied 7 months ago.

Hi Dr. Hasan,


I know I likely appear obsessive over my mouth and I agree I'm spending too much time focusing on it. I do have another question. Does this photo of my tonsils appear normal?


 


In one tonsil (the one appearing smaller which would be the one on the right when looking head on at the photo), there is lymphoid tissue on that tonsil that's not on the other side. You can' see it in the photo because the tissue is lower and my tongue is hiding it.


 


What you can see in the photo, does this appear normal even though they are not the same size?


 


Thank you.


Expert:  Dr. Hasan replied 7 months ago.
HI, Thanks a lot for your input. You can always welcome to ask any doubts you have in your mind because i always feel glad to help you and if you feel comfortable after my opinion, you can always do so. Coming to your question, although the picture is not of good quality but i really don't see anything abnormal. Size of tonsil many a times differ from one side to the other. One tonsil can be slightly bigger than the other side, it is quite normal. So don't worry. Regards
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Customer: replied 7 months ago.
Ok thank you very much.
Expert:  Dr. Hasan replied 7 months ago.
You are most welcome. Just a picture for your help.

http://www.google.com.pk/imgres?safe=off&sa=X&rlz=1C1CHMO_en-GBPK563PK563&espv=210&es_sm=93&biw=1366&bih=642&tbm=isch&tbnid =1PLLdSpPVZFhWM:&imgrefurl=http://meded.ucsd.edu/clinicalmed/head.htm&docid=jgJhM4k4QmMlaM&imgurl=http://meded.ucsd.edu/clinicalmed/head_normal_tonsils.jpg&w=1280&h=960&ei=usS9UuSsCqGE4AT9noCoCg&zoom=1&ved=1t:3588,r:0,s:0,i:98&iact=rc&page=1&tbnh=174&tbnw=243&start=0&ndsp=10&tx=118&ty=102

Open this link and you can see that normal tonsils are not of same size. I hope you are feeling better now. Regards
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Customer: replied 7 months ago.

Thank you for the link but when I paste it in my browser, it just comes up to the google images search page but no actual image....

Expert:  Dr. Hasan replied 7 months ago.

graphicgraphic

 

 

Dr. Hasan, Doctor
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Customer: replied 7 months ago.

Thank you !

Expert:  Dr. Hasan replied 7 months ago.
Most welcome. Regards
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Customer: replied 7 months ago.

By that thing on the inside of my cheek has turned somewhat white in color and the protrusion is just slightly bigger. The other day it was I would say 95% gone. Now it's white in color and the protrusion is slightly raised. I went ahead and scheduled an appointment with my ENT but that's not until January 10. I don't know what it could be, it's strange it would be pretty much disappear and then somewhat come back.

Customer: replied 6 months ago.
Hi,
The thing on the inside of my cheek is slightly raised again. I was curious, if for example this was some type of cancerous lesion, it would not go away on its own and then reappear, correct? If it were cancer, the lesion would get worse and worse over time, not regress and then come back? Or can cancer behave in this manner- appear, get better by itself and then come back?
Than you doctor.
Expert:  Dr. Hasan replied 6 months ago.
Thanks a lot for your input. Yes you are very right, in case of cancer the lesion has to be persistent and progressive. I hope you got my point. Cancerous lesion never gets better , it grows and keep on growing, so just relax and enjoy the new year. Regards
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Customer: replied 6 months ago.
Thank you and happy new year!
Expert:  Dr. Hasan replied 6 months ago.

You are most Welcome :))

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Customer: replied 6 months ago.
Hi Dr Hasan,
I know you said not to worry about this lesion but after I broke off the tip of the growth about two weeks ago, it completely healed, even the little very small leftover raised area. It was fine for about one and a half weeks and then late last week, the area started to protrude again, the same as before with the small protruding tip at the end.
Does this support more that its a papilloma? I have an appointment Friday with my ENT but I am concerned.
Thank you.
Expert:  Dr. Hasan replied 6 months ago.
Thanks a lot for your input. Yes there are chances that it can be papilloma although can't be sure about that. Can give you a better idea if you send me a pic. But there is one thing for sure that it can't be cancer. Here I would like to tell you that don't stress yourself even if it is a papilloma because papilloma never turns into cancer. Good luck for your appointment. Regards
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Customer: replied 6 months ago.

Hi Doctor,


Ok, I promise I will try not to contact so much with my mouth issues and I realize I am obsessing. However, this morning when I woke up I had this strange sensation on the top left side of the inside of my mouth. Almost like a swelling sensation. When I just got home from work, I looked and saw this. I've circled the area that's obviously swollen. I don't think this is a growth, it just looks like the area is swollen. Does cancer usually present in this way?



 

Expert:  Dr. Hasan replied 6 months ago.
Hi, first of all you have to promise me that you will contact me whenever you need because it's always best to be sure. I have reviewed the picture and there is no suspicion of cancer or papilloma for sure. Area is slightly swollen and can be secondary to some trauma due to some hot or sour food but cancer is out of question so just relax. Regards
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Customer: replied 6 months ago.
Ok, yes I promise. I thought maybe this swelling was from the beginning of a salivary gland tumor or lymphoma (you know since I had leukemia in 1994).
I think it's slightly better today but still there.

Also, the area that has the little cheek growth (other side from swelling), reminds me of lichen planus along the inside of cheek in a horizontal line. If this was a papilloma, after I knocked the original small growth off, there was still some protrusion and that protrusion healed only to come back about 2 weeks later.

If this was papilloma, wouldn't the original remaining protrusion never healed in the first place?
Expert:  Dr. Hasan replied 6 months ago.
Thanks :), I don't think so because salivary gland tumor or lymphoma doesn't come out of blue over night. Lichen planus is not possible for the previous swelling and yes in case of papilloma the original remaining protrusion should never have healed in first place. So relax :). Regards
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Customer: replied 6 months ago.
Thank you!
Expert:  Dr. Hasan replied 6 months ago.
You are always welcome dear :)
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Customer: replied 6 months ago.
If I may ask, you say these things like cancer don't show overnight? Couldn't a swelling of an area be the first symptom?
Expert:  Dr. Hasan replied 6 months ago.
Thanks a lot for your input. Yes swelling can be a symptom of cancer but swelling that comes suddenly is never associated with cancer. In medical biopsy for a lesion in mouth is recommended if it has been there for more than 3 months so imagine that oral cancer is not something that we suspect in each and ever swelling or growth of mouth. In past few weeks i have operated many swellings in oral cavity and none of them were cancer. So cancer so far is not something i suspect in your case. Regards
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Customer: replied 6 months ago.
Ok, below the swelling seems to be what looks like bruising, I have had no mouth trauma at all.
Expert:  Dr. Hasan replied 6 months ago.
It's not necessary to have trauma always directly sometime just a hot drink, hot food or spicy food can do so. Bruising does indicate that there is some inflammatory process behind. Regards
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Customer: replied 6 months ago.
So you would still not be concerned and your opinion is unchanged?
Expert:  Dr. Hasan replied 6 months ago.
Definitely yes.
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Customer: replied 6 months ago.

I was reading....back to the growth on the inside of my cheek (the one that healed and came back two weeks later). Is it possible this is leukoplakia? I read some leukoplakia can appear warty looking (I think this was called verrucous??).


 

Expert:  Dr. Hasan replied 6 months ago.
Thanks a lot for your input. No this is not possible because i have seen the initial picture of your lesion and it was not even consistent with verrucous leukoplakia.

Here is a link where you can see that how verrucous leukoplakia looks like.

http://screening.iarc.fr/atlasoralglossdef.php?key=verrucous%20leukoplakia&img

Look it is not at all consistent. Just don't worry.

Regards
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Customer: replied 6 months ago.

I'm trying, I guess the internet does not help. Too many frightening possibilities. I will look at the website you sent. How about this? Frictional kerratosis


Expert:  Dr. Hasan replied 6 months ago.
Frictional keratosis doesn't present over night like you got that lesion. There is a huge difference between what your pic and this one. I have reviewed your previous picture again. Regards
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Customer: replied 6 months ago.

Ok, thank you Doctor.

Expert:  Dr. Hasan replied 6 months ago.
Most welcome dear.
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Customer: replied 6 months ago.

Hello again. Ok, this is the last of my internet research for now as I think I'm scaring myself very much but I also feel I need to be informed. I found a photo I thought looked similar to my swelling (although mine is smaller). I'm thinking is it possible what I'm seeing in my mouth is not swelling but just asymmetry as compared to the other side? I had to angle my camera a certain way to photo it because when looking directly in my mouth, this circled area in the photo I posted to you previously is not obvious.


 


Submucosal mass on the right hard palate, near the junction of the hard and soft palates. A painless swelling of the palate is the most common presenting symptom for tumors of the palatal minor salivary glands.


 



 







Expert:  Dr. Hasan replied 6 months ago.
Thanks a lot for your input. No not at all. What you have is just a localized swelling and not asymmetry. Swellings causing asymmetry takes quite long period to start causing asymmetry. A swelling just found can't cause asymmetry so quickly. Please remember that many diseases just present with a synptom of swelling but not every swelling is cancer. It is pattern of development of swelling and associated symptoms which make us think that they can be cancer or not. I can give you my words that your swelling is not cancer. Regards
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Customer: replied 6 months ago.
Thank you doctor for your continued patience and kindness, it really means so much beyond words.

So you are saying you think my area is not similar to the photo I posted from Internet? The photo I posted looks like such a benign condition, similar to mine.....and please do not worry about scaring me, I need true opinion.

Also, when I meant asymmetry, was referring to just the difference that can occur between one side of the mouth to the other. Meaning I know For example the left area of the mouth may look slightly different from
That exact same area on the right side. Similar to how sometimes tonsils don't look exactly the same.
Expert:  Dr. Hasan replied 6 months ago.
You are always welcome. Yes there is no similarity to your lesion. I am giving my honest opinion as health is a serious matter. Yes we call asymmetry when there is a difference that is significant. But you don't have significant asymmetry. Just sleep and just relax. I give you 100% guarantee :) Regards
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Customer: replied 6 months ago.
Thank you doctor as always!!
Expert:  Dr. Hasan replied 6 months ago.
You are most welcome as always :)
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Customer: replied 6 months ago.
So another words swelling that starts localized and continues to get bigger and then eventually causes obvious asymmetry are worrisome symptoms? Just want to make sure I understand.
Expert:  Dr. Hasan replied 6 months ago.
Yes you got my point that swelling that starts as localized swelling and continues to get bigger and then eventually causes obvious asymmetry is to be worried but that too not always because benign lesions can also present like this. Remember that cancer never gets better, it is persistent and progressive. Your ones has got a bot better as you said so no worries about cancer. Regards
Customer: replied 6 months ago.
Ok thank you. I thought this morning it was better but now honestly I can't really tell yes Or no. It does not look any worse.
Expert:  Dr. Hasan replied 6 months ago.
you are welcome. It is not possible to assess it so early so don't worry. Just forget it for sometime and then assess. Regards

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