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$1 Million Settlement for Medical Malpractice - Undiagnosed Pain in Sinuses Turns Out to be Cancer

In 1996, the plaintiff noticed a small area to the left of her nose that was sore to touch. She was seen by a physician at a medical clinic who thought that her teeth might be the source of the problem. He suggested that she see a dentist.

The plaintiff saw a dentist who initially thought that the pain might be caused by an abscess. The dentist prescribed a round of penicillin, which had little if any effect. Two root canals were performed thereafter on teeth located near the area that was painful. The plaintiff's condition seemed to improve initially, but within a short period of time the plaintiff began to experience pain again.

In early 1997, the plaintiff returned to the medical clinic with complaints of pain and swelling. She was seen by a physician who referred her to the defendant otolaryngologist. The defendant ordered CT scanning of the sinuses, which showed what the radiologist thought was likely to be retention cysts on the left and on the right.

The mass in the left sinus was somewhat larger and was noted to occupy approximately 30 to 40 percent of the maxillary sinus. The defendant otolarnygologist noted in the plaintiff's chart that he thought that the problem was likely dental, and he referred the plaintiff to an oral surgeon.

The plaintiff did not see the oral surgeon recommended by the defendant. Instead, she saw an oral surgeon located closer to her home. The plaintiff told the oral surgeon that she had seen an otolaryngologist; a CT had been performed and was negative; and the otolaryngologist thought that she had some sort of dental problem.

The oral surgeon could not find a dental explanation for her problem and referred her to another oral surgeon. Ultimately, the plaintiff was referred to an orofacial pain specialist who thought that she had some sort of nerve problem.

The defendant testified at his deposition that he referred the patient to an oral surgeon for further evaluation, and he expected the oral surgeon to evaluate the plaintiff's condition from both a medical and dental perspective and to biopsy the area if necessary.

Moreover, the defendant testified that he advised the plaintiff to return for follow-up treatment if the oral surgeon could not find the cause of her pain and swelling or if she continued to experience pain or swelling. Contrary to the defendant's testimony, the plaintiff testified at her deposition that she was not advised by the defendant to return for follow-up.

The plaintiff continued to experience pain thereafter but did not seek further treatment. In March 1999, the plaintiff's dentist suggested that the plaintiff see her primary care physician. The plaintiff saw her primary care physician who immediately ordered a MRI. The MRI showed a large mass filling the entire left maxillary sinus cavity and breaking out of the wall of the sinus and into the tissue of the face. Biopsy was performed, and the mass was found to be adenoid cystic carcinoma, a relatively rare and deadly form of cancer.

Surgery was performed to remove the cancerous mass, which meant removing bone and tissue in an area extending from the roof of the mouth to the bottom of the eye. Thereafter, the plaintiff underwent neutron beam radiation therapy. Multiple reconstructive procedures were performed, but the plaintiff remained significantly disfigured.

The plaintiff's experts were expected to testify at trial that the defendant deviated from the standard of care in failing to biopsy the mass. As a result of the delay in diagnosis, the cancer went undetected, and the mass grew until it had broken out of the wall of the maxillary sinus and eroded through the bone of the hard palate.

The plaintiff's experts were further expected to testify that the surgical procedure to remove the mass was much more extensive than it otherwise would have been two years earlier, resulting in significant loss of function, disfigurement and scarring.

The defendant's experts were expected to testify that the defendant's treatment plan, which involved referral to an oral surgeon, was appropriate, and that the plaintiff should have returned for follow-up treatment if she continued to suffer from pain and swelling.

With regard to causation, the defendant's experts were expected to testify that given the manner in which adenoid cystic carcinoma spreads in the sinuses, there would have been no substantial difference in the plaintiff's treatment had she been diagnosed in 1997; and given the nature of adenoid cystic carcinoma, which is known to recur and metastasize regardless of the stage of diagnosis, the delay in diagnosis could not be shown to make it any more or less probable that the cancer would recur or metastasize.

The case settled just prior to trial.

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