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
Name : 趙 X X Sex : Female Age : 20
Occupation : Student
First visit : 88/10/19
Painless swelling of left maxillary posterior gingival area for 1 month
Past medial history
Past dental history
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
EPT: 22 (4+), 23 (2+), 24 (8+), 25 (8+) Tooth mobility: 22, 23, 24, 25
Amalgam restoration: 14, 46
Posterior open bite: upper left molar area
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.
In OM department:
Clinical impression: ossifying fibroma over R’t
maxilla (tooth 22 to 25) and mandible (tooth 34 to 36 and tooth 44 to 45)
Referred to Dr. 黃逸岳 for further management
In OS department:
Biopsy for L’t maxilla and mandibular lesions
HP report(88/10/30): Florid osseous dysplasia
Keep f/u 6 months later
Check panorex & lower occlusal view
3 years f/u: bony expansion at L’t mandible
Arrange for CT scan: benign cartilagenous tumor at maxilla and mandible,
enchondromatosis is considered first
Painless swelling mass over L’t face
Check panorex: the R-L area ↑
Arrange biopsy on 92/01/21: DC
Check panorex: lesion ↑
Suggest OP after SARS
Arrange OP on 93/01/28 due to mass ↑
Check CT scan: cartilagenous tumors with interval enlargement at maxilla and mandible,
enchondromatosis with malignant transformation is suspected first.
Partial excision & bone trimming over L’t maxilla and mandible
Bone density of maxillary tumor: soft combined hard
Bone density of mandibular tumor: soft
The mass slow growing
Lower lip numbness (+)
The lesion still growing
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.
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
Sinus: cloudy over L’t sinus
Condyle: unremarkable, bilateral Periodontal condition: fair
Missing tooth: 18, 28, 48 Endodontic condition: 14
Filling (e.g. amalgam): 13, 14, 17, 36, 46, 47 Others: 24 rotation, 33, 35 tipping
Inflammation , Cyst , Neoplasm??
Cyst or Neoplasm
Fever or local heat (-) Pus (-)
Destruction of maxilla and mandible with bony expansion
Benign or Malignant
Tenderness (-) Ulceration (-)
Numbness (+) (手術造成) Slow growing (+)
Bony destruction with loosened teeth (+) Well-defined radiolucency
Peripheral or Intrabony Origin
Mucosal lesion (-) Induration (-)
Bony hard in consistency (+) Bone destruction (+)
Intrabony Origin Origin
Florid cemento-osseous dysplasia Cemento-ossifying fibroma
Ameloblastoma, desmoplastic type Calcifying odontogenic cyst
Florid cemento-osseous dysplasia
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.
Most on middle-aged to the elderly.
Common involve female.
Most involve mandibular posterior area.
Painless swelling of the involved bone.
Radiolucent, varying degrees of radiopacity, and with well-defined margin.
Common on third & fourth decades.
Radiographically, it is most often unilocular.
Calcifying epithelial odontogenic tumor (Pindborg tumor)
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.
Most on 30 to 50 years of ages.
Frequently associated with an impacted tooth.
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
No gender predilection Age 30 – 70 y/o
Molar-ascending ramus area (66%)
Calcifying odontogenic cyst
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
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）