Case Report Case Report

39  Download (0)

全文

(1)

Case Report Case Report

D93 Intern K

組員:蘇韋豪 張竣逸 張峰銘 組員:蘇韋豪 張竣逸 張峰銘 塗豐鈞 梅村光志 指導老師

指導老師

林立民教授 陳玉昆主任 王文岑醫師

(2)

General Data General Data

z

Name: 江吳○明

z

Gender:Female

z

Age:54歲

z

Occupation:無

z

Occupation:無

z

Attending VS:

謝天渝醫師 謝天渝醫師

z

First visit:98.7.13

(3)

Chief Complaint Chief Complaint

z

Swelling over right face and bilateral pre

z

Swelling over right face and bilateral pre-

auricular area for 2~3 years

(4)

Present Illness Present Illness

z

This 54 year old female patient has suffered from swelling masses over right face and

from swelling masses over right face and

bilateral pre-auricular area for 2~3 years. She ever went to 高榮 for help and the doctor

ever went to 高榮 for help and the doctor referred her to our OPD for further

examination and treatment (原因不明)

examination and treatment (原因不明).

(5)

Past History Past History

z

Past Medical History

z

Past Medical History

→ DM:under medicine control for 8 years

→ HT: under medicine control for 8 years

→ Drug allergy: denied g gy

→ Hospitalization:thrombocytopenia P t D t l Hi t

z

Past Dental History

→ Routine dental treatment

→ Upper and lower complete denture

→ Attitude:co operative

→ Attitude:co-operative

(6)

Risk Factors Risk Factors

z

Alcohol: (-)

z

Betel quid: (-)

z

Betel quid: (-)

z

Smoking: (-)

z

Other special oral habits: (-)

(7)

Extraoral Examination

(8)

Extraoral Examination Extraoral Examination

Site Right mild

Site Right mild face

Size 5.9×4.5 cm

Shape Dome

Color Ecchymotic

Color Ecchymotic

Consistency Firm Fluctuation

Fluctuation - Mobility Fixed

Pain -

Tenderness - Induration +

(9)

Extraoral Examination Extraoral Examination

Site Right pre- and intra-auricular region

Size 5 1×3 0 cm

Size 5.1×3.0 cm

Shape Dome

C l N l

Color Normal

Consistency Firm Fluctuation - Mobility Fixed

Pain -

Tenderness - Tenderness

Induration +

(10)

Extraoral Examination Extraoral Examination

Site Left pre-auricular

Site p

region

Size 5.0×4.0 cm

Shape Dome

Color Normal

Consistency Firm Fluctuation - Fluctuation

Mobility Fixed P i

Pain -

Tenderness - Induration +

(11)

Extraoral Examination Extraoral Examination

Site Right

submandi submandi bular area

Size 6.5×3.5

cm

Shape Dome

Color Normal

Color Normal

Consistency Firm Fluctuation

Fluctuation

Mobility Fixed

P i

Pain

Tenderness

Induration

Induration

Lymphadenopathy

(12)

Intraoral Examination Intraoral Examination

Site Right buccal mucosa

Size 6.0×2.0 cm

S f S

Surface Smooth

Base Sessile

Sh D

Shape Dome

Color Normal

C i t Fi

Consistency Firm Fluctuation Mobility Fixed Mobility Fixed

Pain

Tenderness

Tenderness Induration

(13)

X-ray finding y g

R.R:16,34,35,42,43,45

Missing:11,12,13,14,15,17,18,21,22,23,24,25,26,27,28,31,32,33,36,37,38,41,44, 46,47,48

Bony density:normal Bony density:normal

Condyle and sinus:normal

Others:resorption of edentulous ridge, no other special finding.

(14)

CT finding-axial view CT finding-axial view

There are 4 round well-defined There are 4 round well-defined homogenerous enlarged mass, A and B located at right side:

A is at right buccal space, A is at right buccal space,

size is measured approximately 5x5 cm in dismeter.

B is at right parotid gland,

A

g p g ,

Size is measured approximately 5X7 cm.

C located at left side :

B C

C is at left parotid gland,

Size is measured approximately 4X4 cm.

(15)

CT finding-axial view CT finding-axial view

D located at right side

D is at submandibular glands,

Size is measured approximately 5X5

D

pp y

cm in diameter.

D

(16)

CT finding-axial view CT finding-axial view

Level 1b Lymphadenopathy

0.5X0.5cm 1X1cm

Level 1b Lymphadenopathy.

(17)

CT finding-coronal view CT finding-coronal view

B C

B

C

Swelling mass B is located at right side, round shaped,extending from condyle neck to mandibular angle, and from ascending ramus to skin, measured about 5X6 cm in g , g ,

diameter.

Swelling mass C is located at left side, round shaped, extending from condyle neck to mandibular angle, and from ascending ramus to skin, measured about 4X5 cm in

diameter.

C is higher than B, difference is about 1.5 cm.

(18)

CT finding-coronal view CT finding-coronal view

A

D

Swelling mass A is at right side round shaped extending from buccinator muscle to Swelling mass A is at right side,round shaped, extending from buccinator muscle to skin, and from zygomatic arch to lower cheek. Measured about 5X5 cm.

Swelling mass C is at left side, irregular shaped, extending from lower margin of Swelling mass C is at left side, irregular shaped, extending from lower margin of mandible to platysma muscle, and from hypoglossal muscle to platysma muscle, measured about 5 X5 cm .

(19)

z

Inflammation?

z

Cyst?

z

Cyst?

z

Neoplasm?

z

Oral maxillofacial manifestation related to

systemic disease y

(20)

z

Fever or local heat: (-)

z

Pain: (-)

z

Pain: (-)

z

Swelling: (+)

z

Purulent drainage: (-)

z

Consistency: firm

z

Consistency: firm

z

Mobility: fixed

z

Fluctuation :(-)

(21)

Neoplasm and

Oral maxillofacial manifestation related to systemic disease

related to systemic disease

(22)

Neoplasm

Benign/Malignant?

z

Fixed

z

No ulceration to skin or mucosa

z

No ulceration to skin or mucosa

z

Slow growth

z

Long duration

z

No pain Benign tumor

z

No pain

z

Induration

z

demarcated margin in CT finding

(23)

Working diagnosis

z

Neoplasm

1

Warthin tumor

1.

Warthin tumor

2.

Pleomorphic adenoma

3

Basal cell adenoma

3.

Basal cell adenoma

z

Oral maxillofacial manifestation l t d t t i di

related to systemic disease

1.

Sjőgren syndrome (primary)

2.

Sialadenosis

3.

Sarcoidosis

(24)
(25)

Warthin tumor Our case

Warthin tumor

Warthin tumor Our case

Gender Male:Female ≒ 10:1 Female (But recently 1:1)

Age Older adults 54 y/o

Age Older adults 54 y/o

Site Parotid gland, mandibular Parotid gland and angle , bilateral submandibular

gland

Pain ( ) ( )

Pain (-) (-)

Growing Slowly Slowly

Consistency Firm Firm

(26)

OUR CASE

OUR CASE

(27)

Pl hi d O

Pleomorphic adenoma

Pleomorphic adenoma Our case Gender Female > Male (slightly) Female

Age Any age

(30~50 is the most common)

54 y/o

( )

Site Parotid gland (53%~77%)

Submandibular gland (44~68%)

Parotid gland and submandibular

l d Minor gland (38~43%) gland

Pain (-) (-)

Growing Slowly Slowly

Consistency Firm Firm

Consistency Firm Firm

(28)

OUR CASE

(29)

Basal cell adenoma

Basal cell adenoma Our case Gender 2:1(female-to-male ratio)( ) Female

Age Any age

(most common in middle-aged

54 y/o (most common in middle-aged

and older adults)

Site Parotid gland (75%)g ( ) Parotid gland Minor salivary gland (25%)

g and

submandibular gland

gland

Pain (-) (-)

Growing Chronic Slowly

Consistency Firm Firm

(30)
(31)

Sjőgren syndrome (primary)

Sjőgren syndrome (primary) Our case

Gender 80~90% in female Female

Gender 80 90% in female Female

Age Middle-aged adult 54 y/o

Site Major salivary gland Parotid gland and b dib l

Usually bilateral submandibular gland

Pain Nonpainful or slightly tender ( ) Pain Nonpainful or slightly tender (-)

Growing Slowly Slowly

(32)
(33)
(34)

Sialadenosis Sialadenosis

Sialadenosis Our case

Gender No particular Female

Age Between 20y/o~60y/o 54 y/o

Sit S li l d ti l l i l i P tid l d

Site Salivary gland,particularly involving parotid gland, usually bilatral

Parotid gland and

submandibular gland

Pain May painful or not (-)

Growing Slowly Slowly

Cause Endocrine ,nutritional ,neurogenic medication

(35)
(36)

Sarcoidosis Our case

Sarcoidosis

Gender Male > Female Female Age Between 20~40 years of

age

54 y/o

S f

Site Mouth floor extend to salivary gland

Parotid gland and submandibular gland

gland

Pain (-) (-)

Glowing Slowly Slowly

Consistency Firm Firm

Consistency Firm Firm

(37)
(38)

Final diagnosis

z Neoplasm

W thi t

Warthin tumor

z Oral maxillofacial manifestation related to systemic disease

Sjőgren syndrome (primary)

Sjőgren syndrome (primary)

(39)

數據

Updating...

參考文獻

相關主題 :