CHIEF COMPLAINT: facial lesion

PRESENT ILLNESS: 54-year-old man presents with what he describes as a slowly
enlarging Right facial mass.  He has not noted any pain.  There
have been some prominent vessels noted over the swelling.  There
is no history of loss of sensation or facial symmetry.  He has
no prior history of skin cancer.  A biopsy of this lesion
revealed a basal cell carcinoma.  Both a CT and an MRI have been
obtained.  These apparently demonstrate a large Right facial
mass which involves the cheek region down to at least the
periosteum of the maxillary bone.  The tumor invades the Right
lateral nasal dorsum and extends into the upper lip. Superiorly
it extends towards the eyelid and laterally to the
lower aspect of the nasal labial fold.

MEDICAL HISTORY: bilateral wrist fracture for which he underwent external
fixation.

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Prior to admission:
A subcutaneous mass involving the Right mid and medial cheek is
apparent.  The tumor extends up to almost the orbital rim and
out laterally to the base of the
nasal labial fold.  The tumor can be palpated in the soft
tissues of the Right upper lip.  His facial nerve function is
intact, and he has good sensation.  The lip elevation is normal.
 The mass, itself, is somewhat mobile over the maxilla.  There
was no palpable adenopathy noted in the head and neck region.
Similarly in the parotid and facial lymph node chains, no
lymphadenopathy
could be appreciated.  On further head and neck exam, the nasal
cavity was free of any distinct disease.  The oral cavity,
oropharynx, larynx, and hypopharyngeal regions were all without
evidence of disease.

FAMILY HISTORY: Familyhistory shows that his father is deceased.  His mother and
three siblings are alive and well.  He is married.  He is a
smoker, and he occasionally drinks alcohol.

SOCIAL HISTORY: He is married.  He is a smoker, and he occasionally drinks
alcohol.
Malignant neoplasm of connective and other soft tissue of head, face, and neck,Infection and inflammatory reaction due to other internal prosthetic device, implant, and graft,Disruption of internal operation (surgical) wound,Pulmonary collapse,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms
Mal neo soft tissue head,React-int pros devic NEC,Disrup internal op wound,Pulmonary collapse,Abn react-anastom/graft,Accid in resident instit,Oth gram negatv bacteria
Admission Date:  [**2142-9-5**]              Discharge Date:   [**2142-10-3**]

Date of Birth:  [**2087-10-9**]             Sex:   M

Service: PLASTIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7733**]
Chief Complaint:
facial lesion

Major Surgical or Invasive Procedure:
[**2142-9-5**]
1. Radical resection of right facial soft tissue carcinoma.
2. Partial rhinectomy.
3. Partial maxillectomy.

[**2142-9-10**]
1. Re-excision of right facial eccrine carcinoma.

[**2142-9-10**]
1. Radical re-excision, adenoid cystic carcinoma, right
    upper lip and cheek (Dr. [**Last Name (STitle) 1837**] and team).
2. Cervical facial bilobed flap to right cheek.
3. Local hair-bearing musculocutaneous flap to right upper
    lip.
4. Free right radial forearm fascial cutaneous flap to
    right cheek internal nasal to right cheek, upper lip and
    nose (microvascular).
5. Split-thickness skin graft to right forearm (15.0 x 8.00
    cm).
6. Revascularization right arm with reverse cephalic vein
    graft (microvascular).
7. Application of short-arm splint.

[**2142-9-17**]
1. Debridement of nonviable tissue right cheek.
2. Partial maxillectomy and exenteration of all mucosal
    tissue.
3. Free rectus abdominis myocutaneous flap to cheek and
    maxillary sinus.
4. Mesh closure of abdomen.

[**2142-9-26**]
OPERATION PERFORMED:
1. Debridement, irrigation and delayed primary closure
    right medial canthal region.
2. Debridement and delayed primary closure of partial wound
    dehiscence right cheek.


History of Present Illness:
54-year-old man presents with what he describes as a slowly
enlarging Right facial mass.  He has not noted any pain.  There
have been some prominent vessels noted over the swelling.  There
is no history of loss of sensation or facial symmetry.  He has
no prior history of skin cancer.  A biopsy of this lesion
revealed a basal cell carcinoma.  Both a CT and an MRI have been
obtained.  These apparently demonstrate a large Right facial
mass which involves the cheek region down to at least the
periosteum of the maxillary bone.  The tumor invades the Right
lateral nasal dorsum and extends into the upper lip. Superiorly
it extends towards the eyelid and laterally to the
lower aspect of the nasal labial fold.


Past Medical History:
bilateral wrist fracture for which he underwent external
fixation.

Social History:
He is married.  He is a smoker, and he occasionally drinks
alcohol.

Family History:
Familyhistory shows that his father is deceased.  His mother and
three siblings are alive and well.  He is married.  He is a
smoker, and he occasionally drinks alcohol.

Physical Exam:
Prior to admission:
A subcutaneous mass involving the Right mid and medial cheek is
apparent.  The tumor extends up to almost the orbital rim and
out laterally to the base of the
nasal labial fold.  The tumor can be palpated in the soft
tissues of the Right upper lip.  His facial nerve function is
intact, and he has good sensation.  The lip elevation is normal.
 The mass, itself, is somewhat mobile over the maxilla.  There
was no palpable adenopathy noted in the head and neck region.
Similarly in the parotid and facial lymph node chains, no
lymphadenopathy
could be appreciated.  On further head and neck exam, the nasal
cavity was free of any distinct disease.  The oral cavity,
oropharynx, larynx, and hypopharyngeal regions were all without
evidence of disease.


Pertinent Results:
[**2142-9-27**] 05:10AM BLOOD WBC-8.6 RBC-2.99* Hgb-9.2* Hct-26.5*
MCV-89 MCH-30.9 MCHC-34.8 RDW-13.1 Plt Ct-555*

SPECIMEN SUBMITTED: right periorbital soft tissue margin,
radical resection of right facial tumor with partial
maxillectomy and rhinectomy, right infra orbital nerve margin.

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2142-9-5**] [**2142-9-5**] [**2142-9-6**] DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/stu

************This report contains an addendum***********

DIAGNOSIS (PRELIMINARY):
I.  Right peri-orbital soft tissue margin (A):

Fibroadipose tissue and skeletal muscle, no malignancy
identified.

 II. Right infra-orbital nerve margin (B):

Peripheral nerve and adjacent fibrous tissue, no malignancy
identified.

III.  Right cheek, partial maxillectomy/ rhinectomy (C - R):

Infiltrating carcinoma with mixed basaloid, eccrine and adenoid
cystic features (2.5 cm), no epidermal origin is identified in
the sections taken.

Tumor invades subcutaneous tissue and skeletal muscle and shows
perineural invasion.

Tumor extends to 0.25 mm of the posterior/deep soft tissue
margin (C), and to 0.7 mm of the inferior soft tissue margin
(N).

Skin, mucosal, and remaining soft tissue margins are free of
tumor.

Keratinized squamous mucosa with focal fibrosis, ? previous
biopsy, and acute and chronic inflammation, free of tumor.

Note:  On sectioning, the tumor was friable and fragmented.
Such fragments adhered to some marginal areas.  Sections showing
the carcinoma with relation to the maxillary bone and sections
of the bony resection margins are being decalcified.  Findings
in these sections and results of additional studies will be
reported in an addendum.

ADDENDUM:

The carcinoma is deeply invasive eccrine carcinoma of mixed
ductal, basaloid, and adenoid cystic types.  The bulk of the
tumor is in the deep dermis, and no epidermal or salivary gland
origin is seen in multiple sections and levels (we do not have
reviewed the original biopsy sections).  Immunohistochemical
stains for Bcl 2 and Cam5.2 are strongly, diffusely positive.
The stain for CK7 is strongly positive in small areas of the
tumor, but completely negative in the majority of the tumor.
CEA, S-100, EMA, and cKIT are negative.  These immunoperoxidase
findings are consistent with the above diagnosis.



Decalcified sections reveal no involvement of the bone,
specifically bony margins are not involved.  Dr. [**Last Name (STitle) **] has
reviewed slides C, H, M, N, P, Q, T-X, and concurs with the
diagnosis.

Addendum added by: DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/srt??????
Date: [**2142-9-11**]
Clinical:   Basal cell cancer, right cheek.
Gross:

The specimen is received fresh in three parts, labeled with the
patient's name, "[**Known lastname 35536**], [**Known firstname **]," and the medical record
number.
Part 1 is additionally labeled "right peri-orbital soft tissue
margin."  It consists of a single fragment of tan and red soft
tissue measuring 0.3 x 0.2 x 0.1 cm. Intraoperative consultation
was obtained. A frozen section was performed. The specimen was
entirely frozen.  Frozen section diagnosis by Dr. [**Last Name (STitle) **] is as
follows: "right peri-orbital soft tissue margin: negative for
carcinoma."   A frozen section remnant is entirely submitted in
A.

Part 2 is additionally labeled "right infra-orbital nerve
margin." It consists of a fragment of red and tan soft tissue
measuring 0.4 x 0.3 x 0.2 cm.  Intraoperative consultation was
obtained. A frozen section was performed. The specimen was
entirely frozen. Frozen section diagnosis by Dr. [**Last Name (STitle) **] is "right
infra-orbital nerve margin: no carcinoma seen." The specimen is
entirely submitted in B.

Part 3 is additionally labeled "radical resection of right
facial tumor with partial maxillectomy and rhinectomy". It
consists of a segment of skin with attached subcutaneous soft
tissue, mucosa and bone measuring 6.5 x 4 x 3.5 cm overall. The
specimen is oriented with three sutures as follows: looped
suture = midline columella, short suture = superior nasal
lacrimal region, and the long suture = lateral. The skin
measures 6 cm x 4.5 cm. The medial aspect of the specimen shows
the columella and opening of the nasal cavity. The skin surface
is remarkable for a centrally located area which is pearly-white
and is devoid of hair follicles, measuring 3 x 1.5 cm. The
center of this area shows telangiectasias, measuring 0.7 x 0.6
cm. The pearly area extends to within 1.2 cm of the medial
margin. On the posterior aspect of the specimen there is a
rectangular fragment of maxillary mucosa measuring 3.0 x 2.8 cm.
The mucosa is pink-tan and shiny with a centrally located
pink-purple erosion measuring 0.5 x 0.2 cm. There are
additionally two areas of hemorrhage located superiorly to the
erosion, measuring approximately 0.2 cm in greatest dimension.
The erosion extends to within 0.5 cm of the nearest surgical
margin. There is an attached segment of bone measuring 4 x 2.5 x
2 cm. It is pink-tan, smooth and shiny, and shows plate-like
projections, representing maxillary sinus. The bone appears
grossly unremarkable. The outer surface of the soft tissue
appears grossly unremarkable. The surgical margin is inked blue.
The specimen is serially sectioned to reveal a multilobulated
mass measuring 2.5 x 2 x 1.5 cm. It has a homogeneous white and
tan cut surface with focal areas of hemorrhage. It extends to
within 0.1 cm of the posterior/deep soft tissue margin (lateral
to the bony fragment), 0.4 cm of the superior soft tissue and
skin margins, 0.6 cm from the inferior soft tissue and skin
margins, 0.8 cm from the lateral soft tissue and skin margins
and 0.6 cm from the medial soft tissue and skin margins.  It
also extends to within 0.1 cm of the skin surface. The mass
extends to within 0.1 cm of both the bone and mucosa. The tumor
does not appear to grossly invade the bone.  The specimen is
represented as follows: C = mass at posterior/deep soft tissue
margin, D = inferior bony margin, E = medial bony margin, F =
superior bony margin, G = lateral bony margin, H = inferior soft
tissue mucosa and skin margin, I = superior mucosal margin, J =
medial mucosal margin, K = lateral mucosal margin, L = mucosa
with erosion, M = mass with superior skin and soft tissue
margin, N = inferior soft tissue margin, O = lateral skin and
soft tissue margin, P = mass with posterior soft tissue margin,
Q = mass in relation to skin, R = medial skin and soft tissue
margin.

Pathology Examination

Name Birthdate    Age     Sex Pathology #     [**Hospital1 18**] [**Known lastname 80368**],[**Known firstname 1955**] E.       [**2087-10-9**]    54 Male      [**-6/4053**]
[**Numeric Identifier 80369**]
Report to:   DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]
Gross Description by:   DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) 63180**]/dif



SPECIMEN SUBMITTED: Re excision of Lateral posterior inferior
margin of right facial carcinoma, Resection Margin Right cheek.

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2142-9-10**] [**2142-9-10**] [**2142-9-13**] DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/mb????????????
Previous biopsies:    [**-6/3993**]  right periorbital soft tissue
margin, radical resection

DIAGNOSIS:

1.  "Re-excision of lateral posterior inferior margin of right
facial carcinoma,"(A-F):

-No malignancy identified, extensive reactive changes; status
post excision (S08-[**Numeric Identifier 80370**]).

2.  Right cheek, resection margin (G-H):

-No malignancy identified, extensive reactive changes; status
post excision (S08-[**Numeric Identifier 80370**]).

Clinical:   Re-excision of lateral posterior inferior margin of
right facial carcinoma.
Gross:  The specimen is received fresh in two parts labeled with
the patient's name, "[**Known lastname 35536**], [**Known firstname **]" and the medical record
number.

Part one is additionally labeled "re-excision of lateral
posterior-inferior margin of right facial carcinoma," and it
consists of an oriented excision of skin with attached soft
tissue measuring 8 x 1 x 4.0 cm. The specimen is sutured to a
surgical towel by the apical and inferior specimen ends, with
the medial, lateral and deep margin aspects annotated on the
towel. The surgeon placed a long suture midway along the lateral
aspect of the specimen to indicate the transition point from
superior to inferior deep margins. The epidermal surface has
short, coarse unremarkable [**Doctor Last Name 352**]/black hairs and is otherwise
grossly unremarkable. The anterior aspect of the specimen shows
the previous surgical cavity has no gross evidence of tumor or
necrosis. The superior and inferior deep margins are inked black
and red, respectively. The posterior/medial aspect of the
specimen has an attached 4.0 x 2.0 cm portion of unremarkable
mucosa. The specimen is serially sectioned perpendicular to the
apical/inferior axis revealing unremarkable tan cut surfaces.
Representative sections of the specimen from the apical to the
inferior deep margins are submitted in cassettes A-F,
respectively.

Part two is additionally labeled "resection margin", and
consists of multiple fragments of unoriented skin measuring 5.8
x 0.8 x 0.4 cm in aggregate. The longest segment is trisected
and the entire specimen is submitted in cassettes G-H.

Pathology Examination

Name Birthdate    Age     Sex Pathology #     [**Hospital1 18**] [**Known lastname 80368**],[**Known firstname 1955**] E.       [**2087-10-9**]    54 Male      [**-6/4185**]
[**Numeric Identifier 80369**]
Report to:   DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]
Gross Description by:   DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/dif

SPECIMEN SUBMITTED: submandibular gland, submandibular lymph
node.

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2142-9-17**] [**2142-9-18**] [**2142-9-21**] DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/ttl
Previous biopsies:    [**-6/4053**]  Re excision of Lateral
posterior inferior margin of right
  [**-6/3993**]  right periorbital soft tissue margin, radical
resection

DIAGNOSIS:

1.  Submandibular gland, right (A-H):

Salivary gland with no carcinoma identified.

2.  Lymph node, submandibular (I):

One lymph node with no malignancy identified and adjacent soft
tissue.  Acute inflammation.

Clinical:   Right facial defect.

Gross:

The specimen is received fresh in two parts, both labeled with
the patient's name, "[**Known lastname 35536**], [**Known firstname **]" and the medical record
number.

Part 1 is additionally labeled "submandibular gland, rule out
adenocystic carcinoma."  It consists of a submandibular gland
weighing 9 grams and measuring 4.6 x 2.7 x 0.7 cm. The specimen
is oriented and the entire surface is inked black.  The specimen
is serially sectioned to reveal tan red cut surface with no
discrete lesions identified. The specimen is entirely submitted
in A-H.

Part 2 is additionally labeled "submandibular lymph node." It
consists of a maroon brown soft tissue measuring 0.8 x 0.4 x 0.3
cm, entirely submitted in I.


Brief Hospital Course:
The patient was admitted on [**9-5**] for radical resection of right
facial soft tissue carcinoma. partial rhinectomy, partial
maxillectomy by the ENT service. Due to postive margins in the
lateral inferior and posterior regions of the specimen that were
less than a millimeter, he underwent reexcision on [**9-10**].

Reconstruction was performed by the plastic surgery service. The
following was performed.

1. Radical re-excision, adenoid cystic carcinoma, right
    upper lip and cheek (Dr. [**Last Name (STitle) 1837**] and team).
2. Cervical facial bilobed flap to right cheek.
3. Local hair-bearing musculocutaneous flap to right upper
    lip.
4. Free right radial forearm fascial cutaneous flap to
    right cheek internal nasal to right cheek, upper lip and
    nose (microvascular).
5. Split-thickness skin graft to right forearm (15.0 x 8.00
    cm).
6. Revascularization right arm with reverse cephalic vein
    graft (microvascular).
7. Application of short-arm splint.

On the fourth or fifth postoperative day signs of demarcation on
the upper 4 or 5 cm of the cheek flap occurred. Thus, several
several additional reconstruction options were performed on
[**2142-9-17**].

1. Debridement of nonviable tissue right cheek.
2. Partial maxillectomy and exenteration of all mucosal
    tissue.
3. Free rectus abdominis myocutaneous flap to cheek and
    maxillary sinus.
4. Mesh closure of abdomen.

Then, on [**2142-9-25**], further surgery was required.  The patient had
a partial wound breakdown in the medial canthal region probably
from drainage from the underlying maxillary sinus. He has had a
trumpet in the right side of the nose which may have blocked
much of the drainage from the sinus into the nose. For this
reason, the trumpet was removed and we went in and irrigated the
maxillary sinus and placed a
Penrose drain.

A second area to be closed was in the right lower cheek where he
also had some partial wound dehiscence. Here, we explored him
for a possible orocutaneous fistula which was not present.

The medical oncology service and radiation oncology services
were consulted, both providing recommendations and follow-up
referrals closer to the patients home.

At the time of discharge, the patient was afebrile, vital signs
were stable, and follow-up was provided.


Medications on Admission:
none

Discharge Medications:
1. Propantheline 15 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
Disp:*90 Tablet(s)* Refills:*4*
2. Scopolamine Base 1.5 mg Patch 72 hr Sig: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours).
Disp:*10 Patch 72 hr(s)* Refills:*4*
3. Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl Topical
TID (3 times a day).
Disp:*1 tubes* Refills:*4*
4. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day).
Disp:*1 qs* Refills:*2*
5. Aspirin 81 mg Tablet, Chewable Sig: Two (2) Tablet, Chewable
PO DAILY (Daily).
Disp:*60 Tablet, Chewable(s)* Refills:*4*
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
7. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4H (every 4 hours) as needed.
Disp:*5 ML(s)* Refills:*10*
8. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**11-22**]
Drops Ophthalmic Q6H (every 6 hours).
Disp:*1 qs* Refills:*4*
9. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: Fifteen (15) ML
Mucous membrane [**Hospital1 **] (2 times a day).
Disp:*60 ML(s)* Refills:*20*
10. Famotidine 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
11. Amoxicillin-Pot Clavulanate 875-125 mg Tablet Sig: One (1)
Tablet PO three times a day for 14 days.
Disp:*42 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] area visiting association

Discharge Diagnosis:
Carcinoma soft tissue right cheek
Partial necrosis tip of cervicofacial flap right side of cheek


Discharge Condition:
stable


Discharge Instructions:
Return to the ER if:
* If you are vomiting and cannot keep in fluids or your
medications.
* If you have shaking chills, fever greater than 101.5 (F)
degrees or 38 (C) degrees, increased redness, swelling or
discharge from incision, chest pain, shortness of breath, or
anything else that is troubling you.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds as ordered.
* Do not drive or operate heavy machinery while taking any
narcotic pain medication. You may have constipation when taking
narcotic pain medications (oxycodone, percocet, vicodin,
hydrocodone, dilaudid, etc.); you should continue drinking
fluids, you may take stool softeners, and should eat foods that
are high in fiber.

Followup Instructions:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] in the hand clinic, [**Hospital Ward Name 516**], [**Hospital Ward Name 23**]
Building [**Location (un) 551**]. You have an appointment on Tuesday, [**10-9**], at 10:10 [**Telephone/Fax (1) 3009**]

Please follow-up with medical oncology. You will be going to
[**Hospital6 8432**] for both your medical and radiation
oncology follow-up. Dr. [**Last Name (STitle) **] will be in touch with you about
your medical oncology provider. [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 80371**] at [**State 48444**] will contact you about your future radiaton treatment in
the next 2 weeks. You records will be sent by Dr. [**Last Name (STitle) 3929**].


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(1) 7738**]

Completed by:[**2142-10-3**]
{'Malignant neoplasm of connective and other soft tissue of head, face, and neck,Infection and inflammatory reaction due to other internal prosthetic device, implant, and graft,Disruption of internal operation (surgical) wound,Pulmonary collapse,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: facial lesion

PRESENT ILLNESS: 54-year-old man presents with what he describes as a slowly
enlarging Right facial mass.  He has not noted any pain.  There
have been some prominent vessels noted over the swelling.  There
is no history of loss of sensation or facial symmetry.  He has
no prior history of skin cancer.  A biopsy of this lesion
revealed a basal cell carcinoma.  Both a CT and an MRI have been
obtained.  These apparently demonstrate a large Right facial
mass which involves the cheek region down to at least the
periosteum of the maxillary bone.  The tumor invades the Right
lateral nasal dorsum and extends into the upper lip. Superiorly
it extends towards the eyelid and laterally to the
lower aspect of the nasal labial fold.

MEDICAL HISTORY: bilateral wrist fracture for which he underwent external
fixation.

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Prior to admission:
A subcutaneous mass involving the Right mid and medial cheek is
apparent.  The tumor extends up to almost the orbital rim and
out laterally to the base of the
nasal labial fold.  The tumor can be palpated in the soft
tissues of the Right upper lip.  His facial nerve function is
intact, and he has good sensation.  The lip elevation is normal.
 The mass, itself, is somewhat mobile over the maxilla.  There
was no palpable adenopathy noted in the head and neck region.
Similarly in the parotid and facial lymph node chains, no
lymphadenopathy
could be appreciated.  On further head and neck exam, the nasal
cavity was free of any distinct disease.  The oral cavity,
oropharynx, larynx, and hypopharyngeal regions were all without
evidence of disease.

FAMILY HISTORY: Familyhistory shows that his father is deceased.  His mother and
three siblings are alive and well.  He is married.  He is a
smoker, and he occasionally drinks alcohol.

SOCIAL HISTORY: He is married.  He is a smoker, and he occasionally drinks
alcohol. 

### Response:
{'Malignant neoplasm of connective and other soft tissue of head, face, and neck,Infection and inflammatory reaction due to other internal prosthetic device, implant, and graft,Disruption of internal operation (surgical) wound,Pulmonary collapse,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms'}
