口腔病理診斷科 Case Report
日期:96/03/27
指導醫師:口腔病理診斷科全體醫師 報告者:Intern-L組
黃英瑋 黃柏青 黃宏興 顏宜貞 張令怡
Personal data
Name: 楊X X
Sex: Male
Age: 24
Occupation: Student
First visit: 96/03/08
Attending VS: Dr. 賴聖宗
Personal data
Present illness Chief complaint
Past medical history Past dental history Oral finding
X-ray finding
?
Chief complaint
Pain and swelling over lower left posterior area for about 1 year.
Personal data
Present illness
Chief complaint
Past dental history Past medical history
Oral finding X-ray finding
Present illness
This 24 y/o male suffered from pain andswelling over left mandibular angle for about 1 year.
Presently, he felt pain with pus discharge when he pressed to left mandibular angle area.
Therefore, he went to LDC for help on 96/03/04.
The dentist took X-ray of teeth 35, 36, 37,and found that there was a radiolucent lesion over the distal apex of tooth 37.
Then the dentist suggested him to our OPD for further treatment.Personal data
Present illness
Chief complaint
Past medical history Past dental history Oral finding
X-ray finding
Past medical history
Arrhythmia
Pneumothorax
Acute gastritis
Hospitalization: (+)
Denied any food or drug allergy.Personal data
Present illness Chief complaint
Past medical history
Past dental history Oral finding
X-ray finding
Past dental history
Scaling
O.D. 、 Endo. Treatment
Extraction
Prosthesis fabrication.
Personal habit:
Alcohol: (+) 1/4 bottle per day
Betel quid: (-)
Cigarette: (+) 5 years, quit for ½ year
Denied any specific oral habit.
Personal data
Present illness Chief complaint
Past medical history
Past dental history
Oral finding X-ray finding
Oral finding
Extra-oral finding
Swelling over left cheek.
Intra-oral finding
Gingival swelling and pus discharge from distal side of tooth 37.
EPT: unknown
Percussion: unknown
Mobility: unknown
Personal data
Present illness Chief complaint
Past medical history Past dental history
Oral finding
X-ray finding
Oral finding
Intra-oral finding
Caries: tooth 27、28、36、37
Missing: tooth 46
Restoration: tooth 17、27、37、48
Prosthesis: tooth 11、16、21、25、
36、45×47
Personal data
Present illness Chief complaint
Past medical history Past dental history
Oral finding
X-ray finding
X-ray finding
Personal data
Present illness Chief complaint
Past medical history Past dental history
There is a well-defined, mutilocular bubble-shaped radiolucnecy around submerged tooth 38 with corticated margin over left posterior mandible
extending from condylar neck down to lower border of mandible and from distal apex of tooth 34 to posterior border of ramus, measuring approximately
9 × 9 cm in diameter.
Oral finding
X-ray finding
X-ray finding
Personal data
Present illness Chief complaint
Past medical history Past dental history
The lesion resulting in vertical bony expansion with cortical border thinning pressed the tooth 38 down to mandibular angle.
The images of left mandibular canal and mental foramen were unclear, and root resorption of tooth 36、37 was noted.
Oral finding
X-ray finding
X-ray finding
Personal data
Present illness Chief complaint
Past medical history Past dental history
Sinus: unremarkable Condyl: left condyl head was flattened Caries:tooth 27、28、36、37
Endodontic condition: Endo. treatment: tooth 11、21
Incomplete Endo. treatment: tooth 16、36
Oral finding
X-ray finding
X-ray finding
Personal data
Present illness Chief complaint
Past medical history Past dental history
Missing:tooth 46 Mesial tilting:tooth 47、48 Restoration (e.g. C & B): tooth 11、16、21、25、36、45×47 Filling (e.g. amalgam): tooth 17、27、37 、 48
Submergence: tooth 38
Oral finding
X-ray finding
X-ray finding
Personal data
Present illness Chief complaint
Past medical history Past dental history
Occlusal film:
There is a well-defined , mutilocular bubble-shaped radioluc since distal side of tooth 34.
The obviously B-L bony expansion over left posterior mandible was noted.
necy extending
Oral finding
X-ray finding
Differential diagnosis
Differential diagnosis
Inflammation, Cyst, or Neoplasm?
Fever or local heat (-)
Fluctuation ( ? )
Pus (+)
Destruction of mandible with bony expansion.
Cyst or neoplasm
Benign
Working Diagnosis
Cyst or Neoplasm
Intra-bony origin
Odontogenic keratosis cyst
Amelablastoma Amelablastic fibroma
Odontogenic myxoma
Differential diagnosis
Benign or Malignant ?
Pain (+)
Tenderness (+)
Ulceration (-)
Numbness (-)
Slow growing (+)
Well-defined radiolucency
Cyst or neoplasm
Benign
Benign
Intra-bony origin Working Diagnosis Odontogenic
keratosis cyst
Amelablastoma Amelablastic fibroma
Odontogenic myxoma
Differential diagnosis
Peripheral, Intra-bony origin?
Mucosal lesion (-)
Induration (-)
Bony destruction (+)
Bony expansion (+)
Cyst or neoplasm Benign
Intra-bony origin
Intra-bony origin
Working Diagnosis Odontogenic
keratosis cyst
Amelablastoma Amelablastic fibroma
Odontogenic myxoma
Working Diagnosis
Odontogenic keratocyst
Amelablastic fibroma
Amelablastoma
Odontogenic myxoma
Cyst or neoplasm Benign
Odontogenic keratosis cyst Intra-bony origin
Working Diagnosis
Amelablastoma Amelablastic fibroma
Odontogenic myxoma
Odontogenic keratosis cyst
Cyst or neoplasm Benign
Intra-bony origin
Odontogenic keratocyst
This case
Age, sex 10~40 y/o slight male 24 y/o male ˇ
X-ray Well-defined mutilocular R-L
Well-defined,
mutilocular R-L ˇ
Jaw 60~80% in mandible, unerupted tooth
Mandible, unerupted
tooth 38 ˇ
Pain Small: painless Large: pain
Pain ˇ
Growth Slowly growing Slowly growing ˇ
Swelling Bony expansion and thinning of cortical plates
B-L cortical expansion ˇ
Effects on tooth
Less root resorption Tooth 36, 37 root resorption
Odontogenic keratosis cyst
Working Diagnosis
Amelablastoma Amelablastic fibroma
Odontogenic myxoma
Amelablastic fibroma
Cyst or neoplasm Benign
Intra-bony origin
Ameloblastic fibroma
This case
Age, sex 20 y/o male, occasional middle-age
24 y/o male ˇ
X-ray Unilocular or mutilocular RL
well-defined,
mutilocular R-L ˇ
Jaw Posterior mandible, 75% unerupted tooth
Mandible, unerupted
tooth 38 ˇ
Pain Painless Pain
Growth Slowly growing Slowly growing ˇ
Swelling Bony expansion &
facial swelling
B-L cortical expansion ˇ
Effects on tooth
Displacement of the involved teeth
Displacement of Tooth
38 ˇ
Odontogenic keratosis cyst Working Diagnosis
Amelablastoma
Amelablastic fibroma
Odontogenic myxoma
Amelablastoma
Cyst or neoplasm Benign
Intra-bony origin
Ameloblastoma This case
Age, sex 30~80 y/o male 24 y/o male X-ray Well-defined , unilocular
or mutilocular R-L
well-defined,
mutilocular R-L ˇ
Jaw Molar-ramus area Mandible, unerupted
tooth 38 ˇ
Pain Painless, paresthesia of the lip
Pain
Growth Slowly growth Slowly enlarging ˇ
Swelling Bony expansion B-L cortical expansion ˇ
Effects on tooth
Root resorption and tooth displacement
Tooth 36, 37 root resorption
ˇ
Odontogenic keratosis cyst Working Diagnosis
Amelablastoma
Amelablastic fibroma
Odontogenic myxoma
Odontogenic myxoma
Cyst or neoplasm Benign
Intra-bony origin
Odontogenic myxoma
This case
Age, sex 25~35y/o, no sex predilection
24 y/o male ˇ
X-ray Multilocular or Unilocular R-L, honeycomb or
tennis-racket pattern.
Well-defined,
mutilocular R-L, soap- bubble pattern.
Jaw Any area in mandible Mandible, unerupted
tooth 38 ˇ
Pain Painless Pain
Growth Slowly enlarging Slowly enlarging ˇ
Swelling Expansion of the jaw B-L cortical expansion ˇ
Effects on tooth
Migration of teeth, root resorption
Tooth 36, 37 root resorption
ˇ
Odontogenic keratosis cyst Working Diagnosis
Amelablastoma Amelablastic fibroma
Odontogenic myxoma