OM case report OM case report
指導老師: 林立民 教授 陳玉昆 主任 王文岑 醫師 陳靜怡 醫師
Intern J 林玲利 9002029 郭哲宇 9002059 楊駿彥 9002079 何樹菁 9002082
General data General data
• Name : 陳
X X
• Sex : male
• Age : 25 y/o
• Native : 高雄縣
• Marital status :
unmarried
• Occupation : 學生
• Attending V.S. : 陳中和 醫師
• First visit : 96/03/14
Chief Complaint
• Pain over lower left posterior gingival area
for one month, especially when eating or drinking.
4/4
Present Illness-1
• Several months ago, he felt tooth mobility of left lower molars, so he went to LDC for help but the dentist told him that all were OK.
• One month ago, he went to USA for study. During
that time, he felt pain attacked over buccal gingival
and mucosal of lower posterior area. So, he went to
LDC in States for help again. After CT examination in
hospital, he was informed that there was a lesion in
his mandible. It may be a cyst or tumor. Hence, he
came back to Taiwan for further treatment.
Present Illness-2
• 96/03/14
Visited our OPD and received CT scan
• 96/03/28
Extraction of tooth 38 and incisional biopsy
was performed.
Past History
• Past Medical History
– Hepatitis B
– Denied any systemic disease – Denied any drug or food allergy
• Past Dental History
– O.D. treatment
• Experience of dental treatment:
– Cooperative
Personal History
• Risk factors related to malignancy
– Alcohol：(-)
– Betel quid：(-)
– Cigarette：(-)
OMF Examination
• Numbness (-)
• Mucosa: intact (mild
reddish)
• No obvious bony
expansion
• No fistula; no discharge
Image finding – Panorex on 960314
Image finding – CT on 96/03/14
Impression:
1) Compatible with ameloblastoma with cortical destruction at left mandibular body and ramus.
Suspect cortical breakthrough at left mandibular angle.
2) Small hypodense lesions in bilateral thyroid gland, suggest further evaluation.
3) Small lymph nodes (<1cm) in submental, bilateral submandibular, bilateral
jugulodigastric and bilateral posterior cervical
spaces.
Differential diagnosis
Inflammation, Cyst, or Neoplasm?
• Fever or local heat (-)
• Fluctuation (-)
• Pus (-)
• Destruction of mandible (+)……
cortical destruction at left mandibular angle
Neoplasm or Cyst
Benign or Malignant ?
• Pain (?)
• Tenderness (-)
• Ulceration (-)
• Numbness (-)
• Slow growing (?)
• Tooth mobility(+)
• Well-defined multilocular radiolucency
Benign
Peripheral, Intra-bony ?
• Mucosal lesion (-)
• Induration (-)
• Bony destruction (+)
• Bony expansion (+): mild
Intra-bony
Working Diagnosis
• Ameloblastoma
• Odontogenic myxoma
• Odontogenic keratocyst
• Ameloblastic fibroma
• Aneurysmal bone cyst
Ameloblastoma Our case Age, sex 20~50 y/o male ○
X-ray Well-defined , unilocular or
mutilocular R-L
○ ○
Jaw Molar-ramus area ○ ○
Pain Asymptomatic, painless
---
Growth Slow growth ---
bony expansion Bony expansion ○
Effects on tooth Root resorption and tooth
displacement
○ ○
Ameloblastoma
Odontogenic myxoma Our case
Age, sex 25~35y/o, no sex
predilection ○
X-ray Multilocular or Unilocular R-L,
honeycomb or tennis- racket pattern.
○ ○
Jaw Any area of jaws ,
mand. > max. ○
Pain Painless ---
Growth Slowly enlarging --- Swelling Expansion of the jaw ○
Effects on tooth Migration of teeth,
root resorption ○ ○
Odontogenic keratocyst Our case Age, sex 10~40 y/o (about 60%),
slight male ○
X-ray Well-defined mutilocular
R-L ○
Jaw 60~80% in mandible, especially in the posterior
body and ascending ramus
○ ○
Pain Small: asymptomatic, painless
Large: pain, swelling, or drainage
---
Growth Slowly growing --- bony expansion Mild bony expansion
and thinning of cortical plates
○
Effects on tooth Less root resorption
X
Odontogenic keratocys
Ameloblastic fibroma
Our case
Age, sex <20 y/o male,
X
X-ray Unilocular or
mutilocular RL ○
Jaw Posterior mandible,
75% unerupted tooth
X
Pain Painless --- Growth Slowly growing --- Swelling Bony expansion &
facial swelling ○
Effects on tooth Displacement of the
involved teeth
X
Aneurysmal bone cyst Our case Age, sex ＜30 y/o
○
X-ray Well-defined mutilocular R-
L( soap-bubble) ○
Jaw more in mandible
○
Pain often pain ---
Growth Growing rapidly ---
bony expansion Bony expansion
and thinning of cortical plates
○
Effects on tooth Displacement or
resorptionthe involved teeth
○ ○
