Intern Case Report

(1)

Intern Case Report

Intern C組：施函緯、林聰緯、柯昭賢、黃慷慧報告日期：100.11.28

指導醫師：口病科全體醫師

(2)

General Data

Name: 林XX

Gender: Female

Age: 37 y/o

Native: Kaohsiung

Marital status: Not married

Birthday: 63.03.29

First visit: 100.11.11

Attending VS: 陳靜怡醫師

(3)

Pain and swelling over left mandible for 2 weeks.

Chief Complaint

(4)

Present Illness

This 37 y/o female felt uncomfortable over lower

left anterior to posterior teeth for 3 weeks. She didn't care about it until the swelling was noted 2 weeks

ago. She visited 大華牙科 on 100.11.11. After

dental X-ray examination at 大華牙科, a lesion over left mandible was found. She was referred to our

OPD for further evaluation.

(5)

Extraoral Examination

Facial swelling over left mandible body

– Consistency: Firm to hard – Redness: (-)

– Local heat: (-) – Pain: (+)

– Numbness: (-)

(6)

Intraoral Examination

Gingival swelling and ridge expansion from tooth 32 to 37

– Size: 8x4 cm – Color: Pink

– Consistency: Firm to hard – Fluctuation: (-)

– Induration(-) – Pain: (+)

– Tenderness: (+)

(7)

Intraoral Examination

Mobility grade Ⅱ:

Mobility grade Ⅰ:

Residual root:

EPT(+):

EPT(-):

4 5 7 8 6

2 4 5 7 8 3 2 1

1 3

(8)

Past History

Past medical history

 Denied any systemic disease

 Denied any drug and food allergy

Past dental history

 OD

 Scaling

(9)

Personal History

Oral risk factors:

 Alcohol drinking: (-)

 Betel nut chewing: (-)

 Cigarette smoking: (-)

Denied other specific oral habits

Attitude toward dental treatment: Cooperative

(10)

Dental Examination

Missing:

Caries:

Residual root:

Amalgam filling:

4 7

4 8 6 6

6

(11)

Radiographic Examination

 Pano: There is a well-defined, not corticated, multilocular, scalloped radiolucency

over left mandible body and symphysis, extending from the apex of tooth 42 to the

distal side of tooth 37 and from alveolar crest to inferior border of mandibular body,

measuring 7x3 cm. There is bony expansion of alveolar crest and mandbular border

in vertical direction.

(12)

Left mandibular canal is downward displaced, with intact cortical bone.

Root resorption of tooth 34, 35, 37 is noted.

Radiographic Examination

(13)

Radiographic Examination

 Occlusal: There is a well-defined, soap-bubble, multilocular radiolucency extending from tooth 32 to the posterior area. Buccal-lingual bony expansion is noticed.

Suspect tooth 34 35 buccal version.

(14)

Radiographic Examination

 Periapical: There is a well-defined, multilocular, soap-bubble radiolucency extending from the mesial side of tooth 42 to the distal side of tooth 37. Root resorption of

tooth 31, 32, 33, 34, 35, 37 is noted.

(15)

Differential Diagnosis

Inflammation, cyst or neoplasm?

Benign or malignant?

Peripheral or intrabony?

(16)

Inflammation, Cyst or Neoplasm?

Pain: (+)

Redness: (-)

Local heat: (-)

Bony destruction and expansion: (+)

Cyst or neoplasm

(17)

Benign or Malignant?

Pain(+), tenderness(+)

Well-defined border

EPT(+) over teeth on the lesion expanded area (except tooth 31, 33)

Benign

(18)

Peripheral or Intrabony?

Bony expansion with a well-defined border.

Intrabony

(19)

Intrabony benign tumor or cyst

Working diagnosis

Benign Tumor

 Odontogenic

 Ameloblastoma

 Odontogenic myxoma

 Ameloblastic fibroma

(20)

 Non-odontogenic Tumor

 Central hemangioma

 Central giant cell granuloma Cyst

 Odontogenic keratocyst (Keratocystic odontogenic tumor)

Intrabony benign tumor or cyst

Working diagnosis

(21)

 Ameloblastoma

 Odontogenic keratocyst

 Odontogenic myxoma

 Ameloblastic fibroma

 Central giant cell granuloma

 Central hemangioma

The List(more possible → less)

Working diagnosis

(22)

Ameloblastoma

Our Case Ameloblastoma

Gender Female Both

Age 37 y/o 30~70 y/o

S / S Painful swelling Painless swelling

Site left mandible body and symphysis 80% posterior mandible

Shape Multilocular, soap-bubble Multilocular, distinct septa, Rarely honeycomb or soap-bubble

Size 8x4 cm variable

Outline Well-defined Smooth and scalloped, well-defined, well-corticated

Effects Bone expansion, root resorption

Adjacent teeth displaced, loosened, often resorbed, extensive expansion in all

directions

(23)

Ameloblastoma

(24)

Ameloblastoma

(25)

Our Case OKC

Gender Female Male slightly higher

Age 37 y/o 60% 10~40 y/o

S / S Painful swelling Large→pain, swelling, drainage Site left mandible body and

symphysis 60~80% posterior mandible

Shape Multilocular, soap-bubble Multilocular

Size 8x4 cm Variable

Outline Well-defined Well-defined, smooth, corticated margin

Effects Bone expansion, root resorption 25~40% unerupted tooth, rare root resorption

Odontogenic Keratocyst

(26)

(27)

Our Case Odontogenic Myxoma

Gender Female Both

Age 37 y/o Mean age 25~30 y/o

S / S Painful swelling Painless expansion

Site left mandible body and

symphysis Mandible

Shape Multilocular, soap-bubble

Unilocular or multilocular with

“stepladder pattern trabeculae” or

“soap-bubble”

Size 8x4 cm Variable

Outline Well-defined Irregular or scalloped

Effects Bone expansion, root resorption Tooth displacement, resorption

Odontogenic Myxoma

(28)

(29)

Our Case Ameloblastic Fibroma

Gender Female Male slightly more

Age 37 y/o Mean age 14 y/o

Site left mandible body and

symphysis Posterior mandible

Shape Multilocular, soap-bubble Multilocular

Outline Well-defined Smooth, well-defined

Effects Bone expansion, root resorbtion

Adjacent teeth displaced, buccal-lingual expansion of jaw, 75% associated with

unerupted tooth

Ameloblastic Fibroma

(30)

Journal of Oral and Maxillofacial Pathology Case Report

Ameloblastic fibroma

in six-year-old male: Hamartoma or a true neoplasm Chhavi Jindal, Reena Sarkar Bhola

Department of Oral and Maxillofacial Pathology, National Dental College and Hospital, Derabassi, Mohali, Punjab, India

(31)

Central Giant Cell Granuloma

Our Case CGCG

Gender Female Female

Age 37 y/o <30 y/o (60% < 20 y/o)

Site left mandible body and symphysis Ant. to the fist molar in mand.

Cross mid-line

Shape Multilocular, soap-bubble Multilocular, soap-bobble, occasionally distinct septa,

Outline Well-defined well-defined, scalloped, non-corticated

Effects Bone expansion, root resorption

Adjacent teeth displacement, bone expanded unevenly  scalloped boarder

 double boundary in occlusal films

(32)

Cross mid-line

Distinct septa

Double Boundary

(33)

Our Case Central Hemangioma

Gender Female M:F=1:2

Age 37 y/o 10~20 y/o

S / S Painful swelling Local gingival bleeding, pain Site Left mandible body and

symphysis Mandible body and ramus

Shape Multilocular, soap-bubble Multilocular; honeycomb or soap- bubble

Outline Well-defined Ill-defined, indistinct margin Effects Bone expansion, root resorption Rare tooth displacement and root

resorption

Central Hemangioma

(34)

Clinical Impression

• Ameloblastoma over left parasymphysis and mandibular body

• Odontogenic keratocyst over left parasymphysis and mandibular body

(35)

• Essentials of Dental Radiography and Radiology, 4

^th

ed.

• Oral and Maxillofacial Pathohlogy, 3

^rd

ed.

• Differential Diagnosis of Oral and Maxillofacial Lesions, 5

^th

ed.

• Oral Radiology, 6

^th

ed.

References

(36)

Discussion

• Histologic pathology

• Aspiration