CASE REPORT Intern - I 組
Intern I 組
組員 組員
廖國良 蕭如君 陳盈璞 陳冠宇
指導老師
林立民 醫師 陳玉昆 醫師 王文岑 醫師 陳靜怡 醫師 林立民 醫師 陳玉昆 醫師 王文岑 醫師 陳靜怡 醫師
General Data
Name：謝XX Gender：Male Gender：Male Age：16
Occupation：學生
Attending V S ：王文岑 醫師 Attending V.S. ：王文岑 醫師 First visit：98/5/20
Chief Complaint Chief Complaint
A swelling mass over lower left vestibule area, extending to nearby teeth for 1 month
Present Ilness Present Ilness
This 16-year-old male patient is suffered fromy p a swelling mass over his left lower vestibule area and the nearby teeth for 1 month He area and the nearby teeth for 1 month. He went to LDC for help a week ago, and the doctor suggested him to come to our OPD for doctor suggested him to come to our OPD for further examination and treatment.
Past History Past History
P t M di l Hi t
Past Medical History
Drug allergy: Denied Taking drug: Denied
Systemic disease: Denied y DM: Denied
HT: Denied HT: Denied
Past Dental History Past Dental History
OD restoration Tx.
Risk Factors Related to Malignancy
Alcohol： (-)
Betel quid： (-) Betel quid： ( ) Smoking： (-)
Intraoral Examination Intraoral Examination
An irregular shaped mass with smooth surface,
il b l l f d l ft l
sessile base, normal color was found over left lower vestibular area and measured about 2.0X2.0 cm in diameter
diameter
Physical Examination Physical Examination
Mobility: Fixed
Consistency: Bony hard Fluctuation (-)
Fluctuation (-) Pain (-)
Tenderness (-) Induration ( ) Induration (-)
Lymphadenopathy( -)
EP test: Tooth 34 (+), tooth 35 (-), tooth 36 (+)
Radiographic Examination (Panoramic film)
There is a well-defined unilocular oval shaped radiolucence with a regular corticated margin between the tooth 34 and 36 apical area, extending from tooth 34 apex area to the furcation area of tooth 36 and from tooth 45 mesial side to mandibular canal
upside, measuring approximately 3.4X2.4 cm in diameter. The lesion push tooth 45 and 46 away and causes tooth 34, 35, and 36 mesial root resorption
Radiographic Examination (Panoramic film)
Unerupted teeth: 18, 28, 38, 48
R t ti 16(O) 17(O) 26(O) 27(O) 36(O) 37(O) 46(O) 47(O) Restoration: 16(O), 17(O), 26(O), 27(O), 36(O), 37(O), 46(O), 47(O)
Radiographic Examination
(Periapical film)
Radiographic Examination
(Occlusal film)
Central
Central or or Peripheral Lesion Peripheral Lesion？ ？ Central
Central or or Peripheral Lesion Peripheral Lesion？ ？
N l l i
N l l i
No mucosal lesion No mucosal lesion Bone destruction (+) Bone destruction (+) Bone destruction ( ) Bone destruction ( )
Central
Central
Inflammation
Inflammation？ Inflammation Inflammation？ ？Cyst ？Cyst Cyst？ Cyst？ ？Neoplasm? ？Neoplasm? Neoplasm? Neoplasm?
Fever
Fever or local heat? ( or local heat? (--)) Pain (
Pain (--)) Pain ( Pain ( ))
Swelling (+)
Swelling (+)→
→bony hard swellingbony hard swelling Purulent drainage (
Purulent drainage (--))
Cyst
Cyst or Neoplasm y y Neoplasm p p
一、
一、Cyst Cyst 一、
一、Cyst Cyst
De elopmental c st De elopmental c st Developmental cyst Developmental cyst
Odontogenic
Odontogenic cyst cyst Odontogenic
Odontogenic cyst cyst
Odontogenic cyst
Odontogenic cyst g g y y
二、
二、Neoplasm Neoplasm p p
→
→Benign or Benign or Malignant ? Malignant ?
Pain ( Pain (--))
Tenderness ( Tenderness (--))
Lymphadenopathy Lymphadenopathy ((--)) Ulceration (
Ulceration (--)) Induration Induration ((--)) Smooth surface Smooth surface Well
Well--defined defined radiolucency radiolucency
B i T B i T
Benign Tumor
Benign Tumor
Benign Tumor Benign Tumor Benign Tumor Benign Tumor
Odontogenic
Non-odontogenic Non odontogenic
Central
Central odontogenic odontogenic cyst cyst or
Central
Central odontogenic odontogenic benign tumor benign tumor or
or or or Central non
Central non--odontogenic odontogenic benign tumor benign tumor
Working diagnosis Working diagnosis
Cyst
Odontogenic keratocyst Odontogenic keratocyst
Od t i t
Odontogenic tumor
Ameloblastoma
C t l d t i fib
Central odontogenic fibroma Ameloblastic fibroma
Non-odontogenic tumor
Central giant cell granuloma
Cyst y
Odontogenic keratocyst
Odontogenic keratocyst Odontogenic keratocyst
Features
It is a distinctive form of developmental
odontogenic cyst. It arises from cell rests of the dental lamina
Common site:
Posterior mandible body and ascending ramus
Usually asymptomatic Size :variable
Size :variable
Well defined radiolucent area with smooth and corticated margin (may appear multilocular, corticated margin (may appear multilocular, particularly in posterior body and ascending ramus)
Odontogenic keratocyst Odontogenic keratocyst
Our case
Odontogenic keratocyst
Gender Male Slightly male predilection
Age 16y/o 10~40y/o
Frequency Make up 3%~11% of all odontogenic cyst
symptom Bony expansion Asymptomatic
symptom Bony expansion Asymptomatic
Site Lower left buccal vestibular area
49% in postetrior mandible body and ascending ramus
Odontogenic keratocyst Odontogenic keratocyst
Our case Odontogenic keratocyst
Odontogenic tumor Odontogenic tumor
Ameloblastoma Ameloblastoma
Central odontogenic fibroma g
Ameloblastic fibroma
Ameloblastoma
Features
May arise from rests of dental laminay Common site:
About 85% of occur in the mandible, most
ft i th di
often in the ascending area Often asymptomatic.
A painless swelling or expansion of the jaw is the usual clinical presentation
X-ray finding often “soap-bubble”
or ”honeycombed” appearance
Ameloblastoma
Our case
Ameloblastoma
Gender Male 沒差別
Age 16 y/o 38~40y/o
f
Frequency 25％ of all odontogenic tumor.
Symptom Swelling mass over his left lower vestibule area and the
Asymptomatic nearby teeth
Site Left lower vestibule area and the nearby teeth
80~85％ occur in the mandibular molar ascending area.
the nearby teeth ascending area.
Color Normal Bluish to normal
Shape Dome, sessile Irregular scalloping
Size 2x2cm ? (外觀通常都很大)
Surface Smooth Smooth
Duration 1 month ?
Duration 1 month ?
Ameloblastoma Ameloblastoma
Our case Unicystic ameloblastoma
Central Odontogenic Fibroma Central Odontogenic Fibroma
Clinical Features:
4-80 years (mean 40) Female: male = 2.2:1
1/3 associated with unerupted tooth 1/3 associated with unerupted tooth SmallerÆ Asymptomatic
BiggerÆ Localized bony expansion or loosening of teeth
Central Odontogenic Fibroma Central Odontogenic Fibroma
Radiographic Features:g p
SmallerÆ well defined, unilocular, radiolucent lesions SmallerÆ Periradicular area of erupted teeth
BiggerÆ Multilocular radiolucience sclerotic border root resorption BiggerÆ Multilocular radiolucience, sclerotic border, root resorption, root divergence
12% exhibit radiopaque flecks
Central Odontogenic Fibroma
Our case
Central Odontogenic Fibroma
Gender Male Female
Age 16y/o Mean age : 40 y/o
Symptom Swelling mass over his left lower vestibule area and the
Asymptomatic or localized bony expansion or loosening of teeth if reach a lower vestibule area and the
nearby teeth
expansion or loosening of teeth if reach a larger size
Site Left lower vestibule area and the nearby teeth
Most in ant. maxilla and post. mandible the nearby teeth
Size 2x2cm -
Shapep Unilocular Small: unilocular
Big: multilocular Outline Well-defined with a regular
corticated margin
Well-defined with a sclerotic border
corticated margin
Relative density
Uniformly RL Uniformly RL
12% exhibit radiopaque flecks
Central Odontogenic Fibroma
Our case Central odontogenic fibroma
Ameloblastic fibroma
Features
True mixed tumor in which epithelial and mesenchymal tissue are both neoplastic Most occur in younger patients: 20 y/o younger
younger
Common site: About 70% of occur in the posterior mandible
Small : Asymptomatic Small : Asymptomatic
Larger :swelling of the jaws
¾ X-ray finding: well-defined RL Small: Usually uniloculary
Larger: Multilocular
Ameloblastic fibroma
Our case
Ameloblastic fibroma
Ameloblastic fibroma
Gender Male Male
Age 16 y/o First two decades
Age 16 y/o First two decades
Symptom Swelling of jaw No symptoms unless or swelling of jaws
Site L’t posterior mandible Posterior mandible (70%) X-ray
finding
A well defined RL with a sclerosis margin
Small- a well defined RL with a sclerosis margin
finding margin sclerosis margin
Ameloblastic fibroma Ameloblastic fibroma
Our case Radicular cyst
Non-odontogenic tumor g
Central giant cell granuloma
Central giant cell granuloma Central giant cell granuloma
Nonneoplastic lesion Age：60% before 60 y/o Sex：Female
Site：70% arise in mandible, more common in anterior portion
common in anterior portion
Sign & symptom：No symptom, painless bony expansion
X-ray finding: Small→unilocular
Large→Multilocular
Our case
Central giant cell granuloma
GGender Male Female
Age 16y/o 60% before 60 y/o
Symptom Swelling mass over his left No symptom painless bony expansion Symptom Swelling mass over his left
lower vestibule area and the nearby teeth
No symptom, painless bony expansion
Sit L ft l tib l d 70% i i dibl i
Site Left lower vestibule area and the nearby teeth
70% arise in mandible, more common in anterior portion
Size 2x2cm 5x5 mm to more than 10 cm in size
Shape Unilocular Small: Unilocular
Big: Multilocular
O tli W ll d fi d ith l W ll d fi d ith t l ti b d
Outline Well-defined with a regular corticated margin
Well-defined without a sclerotic border
