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‧Intern JIntern J
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‧Intern JIntern J
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‧林燕莉林燕莉 莊銘賢莊銘賢
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‧吳庭祐吳庭祐 黃宇婷黃宇婷
報告者 報告者
吳庭祐
吳庭祐 黃宇婷黃宇婷
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‧林立民醫師林立民醫師 陳玉昆醫師陳玉昆醫師
指導醫師
指導醫師 ‧‧王文岑醫師王文岑醫師 陳靜怡醫師陳靜怡醫師
指導醫師 指導醫師
‧
‧98/04/2198/04/21
報告日期 報告日期
N 鄭XX
` Name: 鄭XX
` Sex: 男
` Age: 50
` Native: 高雄縣
` Occupation: 廚師
` Marital Status: 已婚
` Attending VS: 黃逸岳 醫師 (OS dept.)
` First Visit: 98/03/31
` First Visit: 98/03/31
` 2 masses at hard palate for 2~3 months
` 2 masses at hard palate for 2~3 months.
` This 50 y/o male found two masses at the
` This 50 y/o male found two masses at the middle of hard palate for 2~3months.
` He went to 康橋LDC for help because he
` He went to 康橋LDC for help because he
found difficulty to wear his upper RPD. The dentist asked him to stop wearing it for one dentist asked him to stop wearing it for one week, if the mass did not subside, suggested him to come to our OPD for further
him to come to our OPD for further evaluation.
◦ Hypertension
◦ Hypertension
◦ Hepatitis B
◦ 良性血管瘤 (長庚H.檢查)良性 管瘤 (長庚 檢 )
◦ Denied any drug and food allergy
Past Dental History Past Dental History
◦ OD Tx.
Past Dental History Past Dental History
◦ Extraction
◦ Prosthesis fabrication
` Risk factors related to maglinancy
` Risk factors related to maglinancy
◦ Alcohol: (+), socially.
◦ Betel quid: (+) 1~2years quit 30yearsBetel quid: (+), 1 2years, quit 30years.
◦ Cigarette: (+), 5~6yrs, quit 20years.
` Other oral habits: Denied
A t i ( id h d l t )
` Anterior (mid. hard palate)
◦ Smooth surface Reddish
◦ Reddish
◦ Pain(-)
◦ Tenderness(-)Tenderness( )
◦ Consistency: soft to firm
◦ Size: 2.0 x 2.5cm
◦ Mobility: fixed
P t i ( id h d l t )
` Posterior (mid. hard palate)
◦ Smooth surface (multiple nodular) (multiple nodular)
◦ Pinkish
◦ Pain(-)Pain( )
◦ Tenderness(-)
◦ Consistency: hardy
◦ Size: 2.0 x 2.0cm
◦ Mobility: fixed
D t l fi di
` Dental findings
◦ Missing: tooth 15, 16, 17, 18, 24, 25, 26, 27, 28 35 37 38
28, 35, 37, 38
◦ PFM crown: tooth 14, 31, 32, 33
` There is a ill-defined radiolucence with vary degree of radio-opaque
h d l t over hard palate
extending from the
apex of tooth 11 to the apex of tooth 11 to the middle part of the hard palate, measuring about g 2 x 4 cm in size.
` There is a ill defined radiolucence with vary degree of radio opaque over right
` There is a ill-defined radiolucence with vary degree of radio-opaque over right maxillary sinus floor measuring about 4 x 1.5 cm in dimension.
` Condyle: wearing on the left condyle head
` Condyle: wearing on the left condyle head
` Sinus: clear
` C & B: 14, 31, 32, 33 Filling: 36 46
` Filling: 36, 46
` Unerupted teeth: 28, 48
` Generalized horizontal bony defect
` Fever or local heat: (-)
` Fever or local heat: (-)
` Pain: (-)
Lymphadenopathy: ( )
` Lymphadenopathy: (-)
` Surface: smooth, ulceration (-) M bili ( )
` Mobility: (-)
` Induration: unknown
` Consistency: soft to firm
` Duration: 2 months Neoplasm
` Mobility: (-)
` Mobility: (-)
` Ulceration：(-)
L h d th ( )
` Lymphadenopathy：(-)
` Induration：unknown h
` Duration：2 months
` Pain: (-)
` Bone destruction：(+)
` Margin: ill-defined Malignant
Peripheral
Neoplasm Malignant peripheral Neoplasm Malignant peripheral
Polymorphous Adenocarcinoma Adenoid Cystic Carcinoma
Adenoid Cystic Carcinoma
Mucoepidermoid Carcinoma
Our case Polymorphous Our case Polymorphous
adenocarcinoma
Gender Male Female
Age 51 60~80
Symptom Slowly growing mass Painless, bleeding, Symptom Slowly growing mass Painless, bleeding, discomfort feeling Site Hard palate Hard or soft palate Site Hard palate Hard or soft palate
(65%), upper lip, buccal mucosa
Color Red Red
Our case Polymorphous Our case Polymorphous
adenocarcinoma Consistency Soft to Firm soft
Shape Dome shape Dome shape
Size 2.5 x 2 cm Depends
Surface Smooth Maybe ulcerated
duration 2 months Slow growth
Our Case ACC
Our Case ACC
Gender Male No gender predilection
Age 51 Middle age
Symptom Slowly growing mass Slowly growing mass pain
Site Hard palate Hard palate
Color Red Red
Our Case ACC
Our Case ACC
Consistency Soft to Firm Firm
Shape Dome shape Dome shape Size 2.5 x 2 cm Depends
Surface Smooth Smooth
Duration 2 months Slowly growing
Our case Mucoepidermoid Our case Mucoepidermoid
carcinoma
Gender Male Slightly female
predilectiopn predilectiopn
Age 51 20-70
symptom Slowly swelling mass Asymptomatic
swelling, pain or facial nerve palsy
nerve palsy
Site Hard palate Parotid gland, minor salivary gland
Color Red Blue or red
Our case Mucoepidermoid Our case Mucoepidermoid
carcinoma Consistency Soft to firm Soft,
sometimes fluctuant sometimes fluctuant Shape Dome shape Dome shape
Size 2.5x2 cm < 3cm
Surface Smooth Smooth
Surface Smooth Smooth
Duration 2 months Slowly growing
` Adenoid Cystic Carcinoma over right hard
` Adenoid Cystic Carcinoma over right hard palate
` Fever or local heat: (-)
` Fever or local heat: (-)
` Pain: (-)
Lymphadenopathy: ( )
` Lymphadenopathy: (-)
` Surface: smooth, ulceration (-) M bili ( )
` Mobility: (-)
` Induration: unknown
` Consistency: hard
` Duration: unknown
neoplasm, R/O inflammation,
` Surface: multiple nodular cyst
T P l i
Torus Palatinus
Our case Torus Palatinus Our case Torus Palatinus
Gender Male Female
Age 51 30-50
symptom Asymptomatic Asymptomatic
Site Hard palate Hard palate
Color Pink Red
Our case Mucoepidermoid Our case Mucoepidermoid
carcinoma
Consistency Hard Hard
Shape Multi-nodular Multi-nodular
Size 2x2 cm < 2cm
Surface Smooth Smooth
Surface Smooth Smooth
Duration Unknown Slowly growing
` Torus Palatinus over mid-posterior hard
` Torus Palatinus over mid-posterior hard palate
` Impression：
` Impression：
1. Malignant tumor at the right side of hard palate with direct tumor extension into the nasal cavity t d ect tu o e te s o to t e asa ca ty (more on the right), right maxillary sinus, and right pterygopalateine fossa.
2. Bony destruction at right maxillary bone, the hard palate, the inferior portion of nasal septum, and right pter goid plates
right pterygoid plates.
3. Preliminary image staging: stage IV A(T4N0Mx).
` 98/03/31/ /
◦ Incisional biopsy (anterior mass) is performed under local anesthesia. 3 specimens were sent for H-P
examination.
x Soft tissue of flap
Soft tissue of bony cavity x Soft tissue of bony cavity x Bone fragments
◦ Posterior massPosterior mass
x Clinical impression was torus. Patient refused any treatment.
` 98/04/07
` 98/04/07
◦ Suture removal
◦ H-P report: adenoid cystic carcinomaH P report: adenoid cystic carcinoma
◦ CT scan arrangement
` 98/04/14
` 98/04/14
◦ Tumor involved the nasal cavity sinus and pterygomandibular space Æ IMOPERABLE pterygomandibular space Æ IMOPERABLE
◦ Chemotherapy and radiotherapy were arranged.
