Present illness

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(1)

Intern A組

報告日期 : 97.2.26

指導老師 : 口腔病理科全體醫師

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General data

„ Name : 侯XX

„ Age : 46 y/o

„ Gender : Male

„ Occupation : Driver

„ Marital status : Married

„ Native : 嘉義縣

„ 初診日期 : 92.3.26

„ 主治醫師 : 王文岑醫師

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Chief complaint

Receiving NPC post RT follow-up

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Present illness

„ This 46 y/o male patient was receiving NPC post RT follow-up on92/03/26. On 93/09/01, a PAP was

noticed over apex of tooth 45 with percussion pain.

Endodontic treatment was performed with Vitapex dressing and keep f/u .

„ 93/11/12, cystic-like lesion was found over 45 apex, and was suspected to be a radicular cyst. Enucleation was performed by Dr. 沈也雄 and specimen was sent for HP examination.

„ 93/11/19, HP report diagnosed to be ameloblastoma over right mandible premolar area.

(5)

Present illness (Cont.)

„ On 93/12/3, RCF of tooth 45 with GP was performed by Dr.

王文岑.

„ 93/12/3~95/03/8, follow-up with Panorex showed no S/S.

„ 95/05/24, RL over 46 mesial root was noticed to be enlarged.

„ 95/05/24~97/01/16 ,patient lost f/u for 20 months.

„ 97/01/16, multilocular RL was found over 45, 46 area on Panorex with 46 root resorption.

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Past medical history

„ Hepatitis

„ Nasopharyngeal cancer

„ Hypertension

„ Hospitalization (+) : 陰囊水腫

„ Drug allergy (+) : unknown

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Past dental history

„ OD

„ Endo

„ OHI

„ Topical Fluoridation

„ Scaling

„ Smear cytology

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Personal habits

Cigarette smoking (+) : 1 pack/day , quit Alcohol drinking (+) : quit

Betel quid chewing (+) : quit

Denied any other special oral habits

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Intra-oral examination

„ Normal appearing with no obvious swelling over vestibular mucosa of tooth 44, 45, 46.

„ Gingiva recession of tooth 43, 44, 45, 46.

„ Severe occlusal attrition of tooth 44, 45, 46.

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X-ray examination

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93.9.1 93.9.22

93.11.3 93.11.3

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93.11.12

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93.12.3

93.12.3

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94.1.5

94.3.16

94.5.18

94.9.21

94.12.14

95.3.8

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97.1.16

97.1.16

Pre-op ( lost f/u 20 months )

There is a well-defined multilocular irregular-shaped radiolucence without a corticated margin, causing mild mesial displacement of tooth 45 and distal

displacement of tooth 46, extending from distal aspect of tooth 44 to distal aspect of tooth 46.

There is a well-defined multilocular irregular-shaped radiolucence without a corticated margin over right mandible body, causing bony expansion and thining of cortical bone, extending from distal aspect of tooth 44 to distal aspect of tooth 46.

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97.1.16 There is a well-defined multilocular irregular-shaped radiolucence without a corticated margin over right mandible body, causing mild mesial displacement of tooth 45 and distal displacement of tooth 46. It extends from distal aspect of tooth 44 to distal aspect of tooth 46 in one direction and from the alveolar crest down to 2/3 of mandible in other direction, measuring approximately 3 x 3 cm in diameter.

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Inflammation or neoplasm or cyst

Neoplasm or cyst

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Benign or malignant

Benign

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Peripheral or intrabony

Intrabony

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Working diagnosis

„ Ameloblastoma

„ Odontogenic myxoma

„ Odontogenic keratocyst

„ Glandular odontogenic cyst

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Ameloblastoma

好發年齡 10 y/o 以下少見 30~70發生率大約相等

好發位置 Molar-ascending ramus area

臨床症狀 1. Asymptom

2. Painless swelling

3. Expansion of jaw bone

X-ray 特徵 1.Well-defined multilocular R-L with non- corticated margin

2. “Soap bubble” appearance

3. Irregular scalloping margin

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Odontogenic myxoma

好發年齡 25-30歲, 男女機率相等

好發位置 Mandible > Maxilla

臨床症狀 Small : no symptom

Larger : painless swelling of bone

X-ray 特徵 1. Well-defined unilocular or multilocular R-L with no corticated margin

2. Irregular or scalloped margin

3. Soap bubble” appearance

4. Contain thin, wispy, trabeculae of residual bone

5. Cause root resorption, and the displacement of adjacent teeth

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Odontogenic keratocyst

好發年齡 10-40 y/o

好發位置 Mandibular posterior area. ramus

臨床症狀 1. Asymptom

2. Pain, swelling, drainge

3. Antero-posterior direction without obvious bone expansion

X-ray 特徵 Well-defined multilocular R-L with smooth and corticated margin

其他 Unerupted teeth involved

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Glandular odontogenic cyst

好發年齡 Middle-aged

好發位置 Mandibular anterior (cross midline)

臨床症狀 1. Asymptom

2. Pain, paresthesia

X-ray 特徵 Unilocular or multilocular R-L with sclerotic rim

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Clinical impression

Ameloblastoma, right mandibular

body

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97.2.14

Post-op

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Thanks for your attention

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