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原文題目(出處): Mandibular Actinomyces osteomyelitis complicating florid cemento-osseous dysplasia: case report. BMC Oral Health 2011, 11:21.
原文作者姓名: Miller H Smith, Paul W Harms , Duane W Newton, Bill Lebar, Sean P Edwards and David M Aronoff.
通訊作者學校: Department of Oral and Maxillofacial Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
報告者姓名(組別): Intern E組 李惠娜
報告日期: 2012.01.09
內文:
I. Background:
Apart from neoplastic processes, chronic disfiguring and destructive diseases of the mandible are uncommon.
II. Introduction
Actinomycosis
Slowly-progressive infection
Gram-positive, anaerobic
Inflammation with abscesses, tissue fibrosis, and the presence of draining sinus tracts or fistulae
Sulfur granules from erupting sinus tracts
Cervicofacial infections
Generally limited to the soft tissues without spreading to involve neighboring bone tissue
It mimics more common problems such as neoplasia
Actinomycetes are sensitive to many common antimicrobials
Disfiguring or even fatal, if vital structures(such as major arteries and airways) are involved
Florid cemento-osseous dysplasia (FCOD)
Multiple bilateral and often symmetrically extensive lesions
Predominantly in the mandible
Middle-aged African females
Asymptomatic or dull pain
Cotton wool
There is a high preponderance of fibrous tissue and
osteoclasts but rarely inflammation
Possesses a less robust blood supply, thereby resulting in sequestrum
III. Case Presentation:
五十三歲無牙非洲美裔女性
FCOD病史二十年
假牙製作十年,假牙穩定性差
左下顎骨腫一個月,疼痛,在 ramus前方暴露出約一公分的骨頭
Pus(+):白色濃稠有臭味
Multifocal diffuse bony changes consistent with FCOD and a new radiolucency in the bone of the mandible
口腔病理科 On-Line KMU Student Bulletin
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就醫治療
第二週:levofloxacin無效
第二個月:切片但無確診
第七個月:症狀未消(The ulceration and drainage continued)轉診至 University of Michigan Medical hospital
1. Debridment 2. 細菌培養 3. 骨切片
4. 翻瓣修復軟組織
A:Pano顯示cotton wool影像,四個象限均有,但在上顎比較不明顯
B圖:Axial CT
空 心 箭 頭 : hypertrophic, sclerotic and heterogeneous changes of FCOD within the mandible
實心箭頭: a large lytic lesion with loss of bone at its lateral aspect and central sclerosis consistent with infection
C圖:3D CT
空心箭頭對應圖A
實心箭頭顯示因為Actinomyces感染而造成的局部糜爛
組織切片
A: Excised mandibular bone revealed FCOD with irregular cementum
droplets and rounded forms in a fibrovascular stroma (hematoxylin and
口腔病理科 On-Line KMU Student Bulletin
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eosin (H&E),magnification 200 ×)
B:Neutrophilic infiltrate (arrowheads) with adjacent necrotic bone (arrows) (H&E, magnification 400 ×).
C: Gram-positive filamentous organisms in marrow space (arrowheads) (Brown-Hopps stain).
Colonies of filamentous organisms in marrow
IV. Conclusions
We present a complicated association of two uncommon and destructive diseases of bone, FCOD and actinomycosis.
The existing FCOD possibly contributed to a delay in establishing the diagnosis of actinomycosis because the deforming and destructive changes to the mandible produced by the infection were assumed to be due to progressing FCOD.
Healthcare providers should be aware that actinomycosis can be an opportunistic pathogen of the mandible that can establish deforming and severe infections when a break in the integrity of the oral mucosa occurs.
Proper cultures performed under anaerobic conditions are helpful and antimicrobial management should take into consideration.
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Clinicians should be aware of the possibility of actinomycosis arising in the setting of FCOD, and the importance of bone biopsy and cultures in arriving at a definitive and timely diagnosis.
題號 題目
1 放射學檢查與繁盛性牙骨質-骨發育不良
(florid cemento-osseous dysplasia)較不 易區分的疾病為下列何者?
(A) 骨肉瘤(osteogenic sarcoma)
(B) 造釉細胞瘤(ameloblastoma)
(C) 纖維肉瘤(fibrosarcoma)
(D) 家族性巨大型牙骨質瘤(familial gigantiform cementoma)
答案(D ) 出處:參考98年第一次專門職業及技術人員高等考試牙醫師、助
產師、職能治療師、呼吸治療師、獸醫師考試暨牙醫師考試分試 考試(第一試):當年題目為組織學檢查
題號 題目
2 關於放線菌(actinomycetes),下列何者為誤 (A) 是一種絲狀的格蘭氏陽性(Gram's positive) (B) 好氧(aerobic) 及微嗜氧(micoaerophilic) 菌
(C) 葡萄狀黴菌病(botryomycosis)和放射菌((actinomycetes))的膿 液中均常見有硫磺顆粒(sulfur granules)
(D) 常引發多發性膿瘍和瘻管生成
答案( B) 出處:本文和參考96年第一次專門職業及技術人員高等暨普通考試
醫事人員、中醫師、心理師、呼吸治療師、營養師、獸醫人員考試 暨醫師考試分試考試(第一試)