Serendipitous diagnosis of protein S deficiency
Case report published in Journal of periodontology (2002)
Abstract
A 46-year-old male sought periodontal care for a swelling on his right mandibular gingiva. An excisional biopsy revealed a well-differentiated squamous cell carcinoma. Surgical treatment consisted of a right segmental mandibulectomy with ipsilateral right neck dissection and fibular free flap reconstruction. Two days after the surgical procedure, a weakened Doppler signal suggested vascular compromise of the graft. The patient was returned to the operating room where complete thrombosis of the internal jugular vein (recipient vessel) was observed. This event prompted a complete hematological evaluation that disclosed low serum levels of protein S. The patient was started on systemic heparin and local medicinal leeches. A week later, systemic warfarin sodium was added and successfully resolved the vascular compromise of the graft. Two years later, the patient is active and lives a full life with occasional adjustments of warfarin sodium. This case represents the first report on the treatment of gingival carcinoma that led to the serendipitous discovery of an unrelated and unusual systemic condition, protein S deficiency.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
A 46-year-old male sought periodontal care for a swelling on his right mandibular gingiva.
Why This Matters for Hirudotherapy
This case report describes a 46-year-old male who underwent mandibulectomy with fibular free flap reconstruction for gingival squamous cell carcinoma, complicated two days postoperatively by complete thrombosis of the internal jugular vein (recipient vessel). Hematological evaluation revealed protein S deficiency, and the patient was treated with systemic heparin and local medicinal leeches, followed by warfarin, resulting in successful resolution of vascular compromise. This report is directly relevant to hirudotherapy as it documents medicinal leech use for venous congestion/thrombosis in a free flap setting, a well-established indication. However, it is a single case report with no control group, and leech therapy was one component of multimodal management alongside systemic anticoagulants, so outcomes cannot be attributed to leeching alone.
Citation
Serendipitous diagnosis of protein S deficiency
Aguirre A et al. · Journal of periodontology, 2002
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