M2 ANATOMY

A 54-year-old gentleman presented to the Emergency Department with a chief concern of pain and swelling on right side of floor of the mouth. The patient first noticed a swelling in this region beginning three months previously, with the pain aggravated while eating, and gradual worsening of symptoms over this time interval.  Physical examination noted the patient to be alert and oriented in no distress.  His vital signs were as follows: HR 72, RR 16, Pulse Ox 98%, Temp 98.8, BP 124/84.  On oral examination the tongue was slightly elevated and a discreet hard mass was palpable on the floor of the mouth on the right side with a small ulceration towards midline. Through the ulceration a white hard material was seen.  On radiographic examination a radio-opaque mass was demonstrated near the mandibular left canine and premolars.  The heart rate and rhythm were normal with a normal S1, S2 and no murmurs; the lungs were clear in all fields both anteriorly and posteriorly.