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(1)

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

(2)

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

(3)

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

(4)

Present illness

„

This 24 y/o male suffered from pain and

swelling 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

(5)

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

(6)

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

(7)

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

(8)

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

(9)

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

(10)

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

(11)

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

(12)

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

(13)

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

(14)

Differential diagnosis

(15)

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

(16)

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

(17)

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

(18)

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

(19)

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

(20)

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

(21)

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

(22)

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

(23)

Impression

„ Infected odontogenic keratocyst over

left posterior mandible.

(24)

Thanks for your attention

參考文獻

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