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報告日期:97/11/25

指導老師:林立民教授 陳玉昆主任

王文岑主治醫師 陳靜怡住院醫師

報告者:Intern-C組 湯仁牧 李家榮 施賢駿 王天佑

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General data

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Name : 柯 X X

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Sex : 男

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Age : 16 y/o

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Native : 高雄市

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Marital status : 未婚

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Attending V.S. : 孫章唐醫師

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First visit : 94.07.23

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本次報告初診日期 : 97.11.04

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Chief complaint

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A radiolucenct shadow over right lower third molar area area

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Present illness

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This 16 y/o male suffered from a mild swelling with tenderness and discharge at tooth 38 area

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Past history

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Past medical history - Thalassemia

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Past dental history - Extraction

- Periodontal Tx

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Personal habits

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Risk factors relate to malignancy - Alcohol (-)

- Betel quid (-) - Cigarette (-)

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Extra oral examination

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Facial asymmetry : unknown

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Paresthesia or numbness : unknown

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OMF examination

€ Size : 1 X 2 cm

€ Surface : rough

€ Base : sessile

€ Shape : nodule

€ Consistency : unknown

€ Color :unknown

€ Pain : unknown

€ Tenderness : positive

€ Induration : unknown

€ Lymphadenopathy :

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Image Finding

€ Well-defined unilocular, corticated, radiolucent over L’t mandible, extending from 37 distal to middle of

ascending ramus, from 38 edentulous ascending

ramus area down to mandibular canal, approximately

4.0x2.0cm in dimension. Cortical border of mandible is

thinning .

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Image Finding

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Missing:38 48

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Filling:16

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Uneruption:18 28

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Inflammation or Cyst or Neoplasm

•Fever or local heat (+/-)

•Pain (+/-)

•Pus discharge(+)

•Bony expansion(+)

Cyst or Neoplasm

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Benign or Malignant

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Tenderness (+)

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Ulceration (-)

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Numbness (-)

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Well-defined radiolucency

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Slow growing (+)

Benign

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Peripheral, Intra-bony origin

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Induration(-)

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Bony destruction (+)

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Bony expansion (+)

Intra-bony origin

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Working Diagnosis

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Odontogenic keratocyst

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Unicystic amelablastoma

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Ameloblastoma with cystic degeneration

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Odontogenic keratosiscyst

Odontogenic keratocyst This case

Age, sex 10~40 y/o, slight male 16 y/o male X-ray Well-defined mutilocularR-L Well-defined

unilocular R-L Jaw 60~80% in mandible,

uneruptedtooth

Mandible Pain Small: painless

Large: pain

Unknown (may be not)

Growth Slowly growing Slowly growth

Swelling Bony expansion and

thinning of cortical plates

Thinning of cortical plates

Effects on tooth

Less root resorption none

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Amelablastoma(Unicystic type)

Amelablastoma This case

Age, sex 23 y/o male 16 y/o male X-ray Well-defined ,

unilocular R-L

Well-defined unilocular R-L

Jaw Molar-ramus area Mandible

Pain Painless, paresthesia of the lip

Unknown (may be not)

Growth Slowly growth Slowly growth

Swelling Bony expansion Thinning of cortical plates

Effects on tooth

Root resorption and tooth displacement

none

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Impression

€ Infected odontogenic keratocyst over

left posterior mandible.

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Biopsy

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The specimen submitted consisted of 3 soft tissue fragment in 1 bottle fixed in formalin measuring up to 0.7x0.3x0.2 cm in size.

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Grossly, they are white to grayish in color and rubbery in consistency.

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Microscopically, it show Odontogenic Keratocyst

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