Oral Cavity Tumors: Insights on Upper Jaw Issues - Dentistry

Oral tumors, maxillary issues?

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The patient is inquiring about a swelling in the oral maxilla, described as follows:
1.
On January 26, due to exhaustion, the patient fell asleep without brushing their teeth.
In the middle of the night, they noticed a swelling in the right upper maxilla (not adjacent to any teeth).
The swelling is clearly asymmetrical, with a noticeable height difference between both sides.
There is no pain, just a significant difference in height.
When the patient presses on it with their tongue, it suddenly starts to shrink and flatten.
However, fluid begins to appear around the gums and above, and when suctioned, it results in blood-tinged fluid, reducing the large swelling to a small lump.
2.
During this period, the small lump has repeatedly swollen and deflated without pain.
The patient can press on the swollen area with their tongue, but after it reduces to a small lump, the tissue feels somewhat firm, resembling a small cyst with a hard core.
Each time it swells, the surrounding soft tissue also enlarges into a blister, which eventually resolves on its own.
Sometimes, when the lump is swollen, pressing on it with the tongue triggers sharp pain in the roots of the upper teeth, and occasionally, the upper teeth will suddenly ache even without any pressure.
3.
The patient visited two ENT specialists over two weeks.
One prescribed anti-inflammatory medication, suggesting that bone growth might be occurring, possibly something the patient was previously unaware of.
However, the medication and oral ointment were completely ineffective.
The second ENT prescribed antibiotics, indicating a mild infection and inflammation.
After taking the antibiotics for one night, there was slight reduction in swelling the next morning, but thereafter, there was no further effect, and the swelling continued to appear and subside.
4.
The patient began to suspect that it might be a dental issue, with bacteria possibly affecting the upper bone, leading to swelling.
They consulted two dentists, both of whom indicated it was bone tissue, but questioned whether bone could grow so rapidly.
Neither dentist could explain the initial swelling accompanied by blood-tinged fluid.
5.
Subsequently, the patient visited a dental department in a major hospital in Taichung, where an intern was unable to provide a diagnosis and referred them to an oral pathologist.
The pathologist suggested that no medication was necessary and that it would likely resolve on its own, initially suspecting a salivary gland tumor.
6.
After the Lunar New Year, the swelling persisted and recurred.
During episodes of swelling, the entire oral cavity feels tight and uncomfortable, with tooth pain.
The patient consulted a reputable nearby dentist, who recommended seeing an oral surgeon.
They returned to the same major hospital's oral surgery department (as mentioned in point four).
After examination, the oral surgeon consulted with the pathologist, who also suggested a salivary gland tumor but could not explain the initial swelling with blood-tinged fluid or provide a definitive treatment for the current lump.
The only options presented were to monitor whether it resolves on its own or, if discomfort persists, to consider surgical removal.
The patient has raised concerns with the oral pathologist and oral surgeon about the possibility of a bacterial infection affecting the bone, leading to the swelling.
Despite nearly a month passing, the specialists do not believe this is the case and indicated that a biopsy and bacterial culture would likely not yield significant results.
When the patient inquired why the swelling might trigger tooth pain, the doctor attributed it to neural conduction issues in the brain.
The patient is now uncertain about which specialty to consult, as the doctors' responses have not provided reassurance, and the condition has not improved.
They seek guidance on where to seek further medical attention to identify the underlying cause.
Thank you.

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Xiao Qiao, 30~39 year old female. Ask Date: 2024/02/17