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
General Data General Data
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Name: 江吳○明
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Gender:Female
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Age:54歲
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Occupation:無
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Occupation:無
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Attending VS:
謝天渝醫師 謝天渝醫師
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First visit:98.7.13
Chief Complaint Chief Complaint
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Swelling over right face and bilateral pre
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Swelling over right face and bilateral pre-
auricular area for 2~3 years
Present Illness Present Illness
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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).
Past History Past History
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Past Medical History
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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
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Past Dental History
→ Routine dental treatment
→ Upper and lower complete denture
→ Attitude:co operative
→ Attitude:co-operative
Risk Factors Risk Factors
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Alcohol: (-)
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Betel quid: (-)
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Betel quid: (-)
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Smoking: (-)
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Other special oral habits: (-)
Extraoral Examination
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 +
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 +
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 +
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 +
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 +
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.
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.
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
CT finding-axial view CT finding-axial view
Level 1b Lymphadenopathy
0.5X0.5cm 1X1cm
Level 1b Lymphadenopathy.
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.
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 .
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Inflammation?
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Cyst?
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Cyst?
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Neoplasm?
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Oral maxillofacial manifestation related to
systemic disease y
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Fever or local heat: (-)
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Pain: (-)
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Pain: (-)
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Swelling: (+)
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Purulent drainage: (-)
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Consistency: firm
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Consistency: firm
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Mobility: fixed
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Fluctuation :(-)
Neoplasm and
Oral maxillofacial manifestation related to systemic disease
related to systemic disease
Neoplasm
Benign/Malignant?
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Fixed
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No ulceration to skin or mucosa
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No ulceration to skin or mucosa
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Slow growth
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Long duration
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No pain Benign tumor
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No pain
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Induration
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demarcated margin in CT finding
Working diagnosis
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Neoplasm
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Warthin tumor
1.
Warthin tumor
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Pleomorphic adenoma
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Basal cell adenoma
3.
Basal cell adenoma
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Oral maxillofacial manifestation l t d t t i di
related to systemic disease
1.
Sjőgren syndrome (primary)
2.
Sialadenosis
3.
Sarcoidosis
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
OUR CASE
OUR CASE
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
OUR CASE
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
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
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
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