80+ yo lady with fistula draining from hard palate to nasal cavity. Related to previous traumatic injury. Previously the cyst was not draining, causing recurrent infections. Now with fistula, patient experiences post nasal drip but no recurrent infections and nil other concerning fx. Option of surgical repair given to patient.

Background

• Metastatic SCC with axillary LN involvement (primary unknown). Recent radiotx to axilla.
• Bilateral massive PE Sep ’22 (presumably due to thrombophilia from SCC)

Issues

• ? appropriate to proceed with OT while SCC progression risk remains unclear. No oncologist review post radiotx. ? Plan.
• VTE mx and timing

Discussion

• Palate issue not affecting QoL. Surgeon agrees that surgery is not essential and certainly not time sensitive but patient keen to go ahead. Reasons unclear.
• Oncologist reviewed – review in 12/12. Nil concerns raised by them.
• Patient aware of VTE risks and other perioperative risks. 
•  >3/12 since PE therefore highest risk time has passed. Appropriate for temporary NOAC cessation.

Plan

• Discuss with patient and proceed if this remains their choice.