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口腔病理診斷科 Case report

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口腔病理診斷科 Case report

報告者: intern A 組

陳谷銘 周昱廷 葉裕全 蔡佳真 林永漢 報告日期: 96/02/26

指導醫師: 口腔病理診斷科全體醫師

(2)

General data

Name : 趙 X X Sex : Female Age : 20

Occupation : Student

First visit : 88/10/19

(3)

Chief complaint

Painless swelling of left maxillary posterior gingival area for 1 month

Past medial history

NP

(4)

Past dental history

Scaling

O.D

(5)

Intra-oral finding

Well-defined lesion Tenderness (-)

Induration (-) Painless

2.5 cm× 2 cm in diameter

Labial aspect over tooth 22 ~ 25

Smooth surface with normal appearance mucosa Bony hard in consistency

Fixed

EPT: 22 (4+), 23 (2+), 24 (8+), 25 (8+) Tooth mobility: 22, 23, 24, 25

(6)

Intra-oral finding

Amalgam restoration: 14, 46

Posterior open bite: upper left molar area

Extra-oral finding

NP

(7)

Present illness

88/10/19

„ This 12 y/o girl had gingival swelling over upper post. area for a month. The swelling mass is non- tender, fixed and painless, measuring about 2.5 x 2 cm in diameter. She went to LDC and the dentist suggested her to come to our OPD for further tx.

(8)

Present illness

88/10/19

„ In OM department:

Š Clinical impression: ossifying fibroma over R’t

maxilla (tooth 22 to 25) and mandible (tooth 34 to 36 and tooth 44 to 45)

Š Referred to Dr. 黃逸岳 for further management

„ In OS department:

Š Biopsy for L’t maxilla and mandibular lesions

Š HP report(88/10/30): Florid osseous dysplasia

Š Keep f/u 6 months later

(9)

Present illness

91/07/20

„ Check panorex & lower occlusal view

„ 3 years f/u: bony expansion at L’t mandible

„ Keep f/u

(10)

Present illness

91/07/20

„ Arrange for CT scan: benign cartilagenous tumor at maxilla and mandible,

enchondromatosis is considered first

(11)

Present illness

92/01/18

„ Painless swelling mass over L’t face

„ Check panorex: the R-L area ↑

„ Arrange biopsy on 92/01/21: DC

(12)

Present illness

92/08/19

„ Check panorex: lesion ↑

„ Suggest OP after SARS

(13)

Present illness

93/01/17

„ Arrange OP on 93/01/28 due to mass ↑

(14)

Present illness

93/01/17

„ Check CT scan: cartilagenous tumors with interval enlargement at maxilla and mandible,

enchondromatosis with malignant transformation is suspected first.

(15)

Present illness

93/01/28--OP

„ Partial excision & bone trimming over L’t maxilla and mandible

„ Bone density of maxillary tumor: soft combined hard

„ Bone density of mandibular tumor: soft

93.1.26

(16)

Present illness

93/02/21

„ Numbness (+)

„ Pain ↓

„ Continuous f/u

(17)

Present illness

93/07/31

„ Numbness (+)

(18)

Present illness

93/07/31

„ Check panorex

(19)

Present illness

94/07/16

„ Check panorex

„ The mass slow growing

„ Lower lip numbness (+)

(20)

Present illness

96/02/08

„ Check panorex

„ The lesion still growing

(21)

Panorex

(22)

X-ray finding

There was a well-defined, expansile, unilocular, radiolucent lesion with

corticated margin containing radiopaque foci over the bilateral mandibular body.

The lesion extended from the mesial

aspect of tooth 37 to the apex of tooth 47

and from the inferior border of mandible

up to nearly the alveolar crest, measuring

approximately 14.8㎝× 5.6㎝ in diameter.

(23)

X-ray finding

This mass involved teeth from 47 to 37, and divergency of the root of the teeth 33, 35 was noted, but the root of teeth and PDL appeared to be intact.

There was a downward displacement of

the bilateral mandibular canal and the

obvious bony expansion of mandibular

body.

(24)

X-ray finding

Sinus: cloudy over L’t sinus

Condyle: unremarkable, bilateral Periodontal condition: fair

Calculus: mild

Missing tooth: 18, 28, 48 Endodontic condition: 14

Filling (e.g. amalgam): 13, 14, 17, 36, 46, 47 Others: 24 rotation, 33, 35 tipping

(25)

Differential diagnosis

(26)

Inflammation , Cyst , Neoplasm??

Cyst or Neoplasm

Fever or local heat (-) Pus (-)

Fluctuation (-)

Destruction of maxilla and mandible with bony expansion

(27)

Benign or Malignant

Pain (-)

Tenderness (-) Ulceration (-)

Numbness (+) (手術造成) Slow growing (+)

Bony destruction with loosened teeth (+) Well-defined radiolucency

Benign

Benign

(28)

Peripheral or Intrabony Origin

Mucosal lesion (-) Induration (-)

Bony hard in consistency (+) Bone destruction (+)

Intrabony

Intrabony Origin Origin

(29)

Working diagnosis

Florid cemento-osseous dysplasia Cemento-ossifying fibroma

Pindborg tumor

Ameloblastoma, desmoplastic type Calcifying odontogenic cyst

(30)

Florid cemento-osseous dysplasia

High compatible

Multifocal lesion in the posterior portions of jaws. (some involve anterior mandible).

Bilateral and symmetric involvement.

Asymptomatic, some degree of expansion may be noted.

Common involve woman.

Initially, the lesions are predominantly radiolucent but with time become mixed.

Low compatible

Most on middle-aged to the elderly.

(31)

Cemento-ossifying fibroma

High compatible

Common involve female.

Most involve mandibular posterior area.

Painless swelling of the involved bone.

Radiolucent, varying degrees of radiopacity, and with well-defined margin.

Low compatible

Common on third & fourth decades.

Radiographically, it is most often unilocular.

(32)

Calcifying epithelial odontogenic tumor (Pindborg tumor)

High compatible

Most found in the posterior portions of jaws.

Painless, slow-glowing swelling.

Radiographically, most multilocular radiolucent defect with scalloped margin, and may contain calcified structures.

Low compatible

Most on 30 to 50 years of ages.

Frequently associated with an impacted tooth.

(33)

Ameloblastoma, desmoplastic

High compatible

Asymptomatic Mandible (85%)

Slow-growing, painless swelling of the jaw

Well-defined multilocular RL lesion with irregular scalloped margin (86%)

Displacement of teeth and resorption of roots

Low compatible

No gender predilection Age 30 – 70 y/o

Molar-ascending ramus area (66%)

(34)

Calcifying odontogenic cyst

High compatible

Intraosseous lesion(13 ~ 30 % extraosseous)

Equal frequency in the maxilla and mandible Unilocular(may be multilocular), well-defined radiolucency

Root resorption or divergence of adjacent teeth

Low compatible

Average 33 y/o (most in 20 ~ 30 y/o, from infant to elder) 65 % in the incisor and canine area

Radiopaque structure within the lesion, irregular

calcification or toothlike densities, 1/3 ~ 1/2 of cases 1/3 associated with an unerupted tooth(most canine)

most 2.0 ~ 4.0 cm,(12.0 cm have been noted)

(35)

Impression

Florid cemento-osseous

dysplasia, left maxilla and

bilateral mandibular body

(36)

Thank you for your attention !!

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