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What to do next. Perform a thorough head and neck exam under anesthesia Perform triple endoscopy: ( nasopharyngolaryngoscopy , bronchoscopy , esophagoscopy ) Get a biopsy of the oral cavity ulcer. Thorough head and neck exam. Biopsy of primary

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what to do next
What to do next
  • Perform a thorough head and neck exam under anesthesia
  • Perform triple endoscopy: (nasopharyngolaryngoscopy, bronchoscopy, esophagoscopy)
  • Get a biopsy of the oral cavity ulcer
thorough head and neck exam
Thorough head and neck exam
  • Biopsy of primary
  • Fine needle aspiration of possible neck metastasis
  • Imaging studies:
    • Chest radiograph: posteroanterior and lateral
    • CT/MRI of primary and neck
    • Panorex or dental x-ray: evaluate mandible invasion if CT/MRI not performed
    • Barium swallow
thorough head and neck exam1
Thorough head and neck exam
  • Laboratory tests
    • Pre anesthesia testing
    • Basic liver function tests


-Radiation therapy -for adjuvant or definitive therapy considerations

-Dental: pre radiation dental treatment and for post therapy

examination under anesthesia
Examination under Anesthesia
  • Nasopharyngolaryngoscopy and pharyngoscopy
  • Esophagoscopy
  • Bronchoscopy
  • diagnostic medical procedure that uses a flexible fibre-optic endoscope to visualize the structures inside the nasal passages, including the sinus openings, the larynx, and the vocal cords.
  • technique of placing a rigid or flexible endoscope via the mouth to visualise the pharynx (back of the throat). This technique provides direct visualisation of this structure under magnification allowing structural abnormalities to be diagnosed and any diseased areas to be accurately sampled (biopsied). 
  • direct visual examination of the esophagus with an esophagoscope. Esophagoscopy usually is done as a diagnostic procedure for the purpose of locating and inspecting a disorder of the esophagus
  • Bronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy


  • Nasopharyngolaryngoscopy⊖; Biopsy of ulcer: well-differentiated squamous cell cancer
  • Fine needle biopsy of neck mass: Chronic Lymphadenitis