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指導老師

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指導老師:口腔病理診斷科全體醫師

Intern B組 陳信佑 張元瀚 王紹光 羅竣元 日期:100.10.28

(2)

General data

Name :丁X幸

Sex :Female

Age :46

Native : Kaohsiung

Marital status :Married

Birthday : 53.10.24

First visit :100.10.13

(3)

Chief complaint

1 year ago, after extracted upper

left posterior teeth, she felt water

entering her nasal cavity when she

drank water.

(4)

Present Illness

This 47 y/o female suffered from

oroantral fistula after extracted tooth 25 1 year ago. So, she come to our OPD for extraction evaluation and further

treatment. After our examination, we

discovered that a swelling mass over

her upper left posterior hard palate.

(5)

Intraoral examination

Size : 2X1.5cm

Shape : dome

Color : red

Smooth surface

Pain : (-)

Tenderness : (-)

Induration : (-)

Consistency : firm

Mobility : fixed

Flucutation : (-)

Ulcer : (-)

Border: Extending from tooth 24(D) to tooth 27

(D-1cm) and from cervical margin to mid-line of

hard palate

(6)

Intraoral examination

 Dental findings

 Crown & Bridge: tooth 4X16;

35X37

(dislodgement)

 Metal filling: tooth17, 45

 Residual root: tooth 24, 27, 46

Missing: tooth 18, 25, 28, 37, 38, 47 &

48

 Tilting: tooth 27

(7)

Past History

Past Medical History

Denied any systemic diseases

Denied any drugs or food allergies

Past Dental History

Extraction

Oroantral fistula

Restoration

OD

Endo

Scaling

(8)

Personal History

Oral habits

Alcohol drinking :(-)

Betel-quid chewing :(-)

Cigarette smoking :(-)

(9)

Family History

Non-contributory to this problem

(10)

Panorex view (100.10.13)

•TMJ: L’t, unremarkable

• R’t, flattening of anterior pole

(11)

Panorex view (100.10.13)

There is a well-defined soft tissue shadow extending from tooth 26 distal to residual root 27 distal,

measuring approximately 2.0X1.5cm in dimension

(12)

• Dental findings

Residual teeth: 24, 27, 46

Endo treatment: tooth 35, 46

Panorex view (100.10.13)

Crown & bridge: 14X16

Post & core: tooth 35

(13)

•Dental findings

Metal filling: tooth 17, 21(m), 26,45 Caries: tooth 13(d),14,34(m),36,44(d )

Panorex view (100.10.13)

Missing: tooth 18,25,28,37,38,47,48

(14)

Periapical view (100.10.13)

Left maxillary sinus floor downward displacement residual root: tooth 24, 27

Metal filling : tooth 26

(15)

Periapical view(100.10.13)

There is a soft tissue shadow at the distal

aspect of residual root 27.

(16)

Different diagnosis

Inflammation, cyst, or neoplasm

Benign or malignant?

Intrabony or peripheral?

(17)

Inflammation or cyst or neoplasm

Redness:(+)

Swelling :(+)

Fever:(-)

Pain: (-)

Tenderness:(-)

Fixed:(+)

Fluctuation:(-)

Neoplasm

(18)

Benign or malignant

Pain: (-)

Tenderness: (-)

Consistency: firm

Ulceration: (-)

Induration: (-)

Lymphadenopathy: (-)

Benign

(but cannot rule out low-grade malignancy)

(19)

Intrabony or peripheral

Induration: (-)

Bony destruction: (-)

Bony expansion: (-)

Peripheral

(20)
(21)

Working diagnosis

Pleomorphic adenoma

Benign lymphoepithelial lesion

Basal Cell Adenoma

Canalicular adenoma

Polymorphous low-grade adenocarcinoma

(22)

Benign Tumors

Benign Salivary Gland Tumors

Ellis et al.

(United States 1991)

Eveson and Cawson(Gr eat Britain 1985)

Thackray and

Lucas (Great Britain 1974)

Eneroth (Sweden, 1971)

Foote and Frazzel (United States, 1953) Total number of

cases 1235 257 60 170 107

Pleomorphic

adenoma 53.3% 59.5% 68.0% 60.0% 43.9%

Basal Cell adenoma 1.0% - - - -

Other benign tumors 1.7% 1.9% 0.0% - 0.0%

(23)

Pleomorphic adenoma

(24)

Our Case

Pleomorphic

adenoma

(25)

Our Case Pleomorphic adenoma

Gender Female Slight female predilection O

Age

46 y/o Young and 30-60 years old O

S / S

Painless swelling Painless swelling O

Site

Upper left posterior

palate 60% in palate O

Shape

Dome Dome O

Size

2X1.5cm

variable

O

Induraion

- - O

Tenderness

- - O

Color

Normal to red Normal or blue O

Pleomorphic adenoma

(26)

Benign

lymphoepithelial lesion

(27)

Our Case

Benign lymphoepithelial lesion

(28)

Our Case Benign lymphoepithelial lesion

Gender

Female Female>Male O

Age

46 y/o Adult, with a mean age of 50 O

S / S

Painless swelling Painless swelling O

Site

Upper left posterior

palate Parotid glands X

Shape

Dome Dome O

Color

Normal to red Normal O

Induration

- - O

Tenderness

- - O

Benign lymphoepithelial lesion

(29)

Basal cell adenoma

(30)

Our Case

Basal cell adenoma

(31)

Our Case Basal Cell Adenoma

Gender

Female Female>Male O

Age

46 y/o Middle-age and older adults O

S / S

Painless swelling Painless swelling O

Site

Upper left posterior

palate Parotid gland X

Shape

Dome Dome O

Color

Normal to red White with pink to purple X

Induration

- - O

Tenderness

- - O

Basal Cell Adenoma

(32)

Canalicular adenoma

(33)

Canalocular adenoma

Our case Canalicular adenoma

Age 46 Older adults, peak

prevalence 60~70 y/o X

Gender Female Female,

female: male=1.8:1

O

Site Upper left posterior palate Upper lip(75%), buccal mucosa

X

S & S

Painless swelling, firm or fluctuant

Painless swelling, firm or fluctuant

O

Shape

Dome Dome O

size

2X1.5 cm Several mm to 2 cm O

color

Pink to red normal or bluish X

Induration

- - O

tenderness

- - O

(34)

Polymorphous low-

grade adenocarcinoma

(35)

Our Case

Polymorphous low-grade

adenocarcinoma

(36)

Our Case Polymorphous low- grade adenocarcinoma

Gender

Female Male< Female O

Age

46 y/o Older adults; peak prevalence

60~80 y/o X

S / S

Painless swelling Painless swelling O

Site

Upper left posterior palate

Hard or soft palate; upper lip

and buccal mucosa O

Size

Dome Dome O

Shape

2X1.5cm <3cm O

Induration

- - O

Tenderness

- - O

Polymorphous low-grade

adenocarcinoma

(37)

Clinical Impression

Pleomorphic adenoma, hard palate, left

(38)

References

Oral & Maxillofacial Pathology, 3nd edition

Differential Diagnosis of Oral and Maxillofacial

Lesions

(39)

Thanks for your attention

參考文獻

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