Case report
報告日期:97. 09.29
指導老師:林立民 陳玉昆 王文岑 陳靜怡 組員: Intern E組
曹博竣 張家禎 黃華卿 沈明萱
General data
• Name: 吳XX
• Gender :女
• Age:15
• Native:台灣
• Occupation:學生
• Attending V.S: 黃逸岳醫師
• First visit:96.08.22
Chief complaints
• Swelling over right submandibular area for about 4 years.
Present illness
960822
• this 15 y/o female first came to our OPD on 960822 due to swelling over R’t
submandibular space for about 4 years,
especially after meals, then she was taken the occlusal film and sialolithiasis was
impressed, then she was refered to Dr. 黃 逸岳
Past history
• Past medical history
1.Denied any drug and food allergy
2.Denied other major systemic diseases 3.Hospitalization experience (-)
4.Major surgery under GA (-)
• Past dental history
1.Experience of regular dental tx: acceptable 2.Oral hygiene: poor
Personal history
• Alcohol(-)
• Betel quid(-)
• Cigarette (-)
Oro-maxillo-facial examination
• Size: 6 x 5 cm
• Surface: smooth
• Base: sessile
• Shape: dome shaped
• Color: unknown
• Consistency: soft
• Fluctuation: unknown
• Mobility: fixed
• Pain: (-)
• Tenderness: (-)
• Induration: (-)
• Lymphadenopathy: (-)
960822 occlusal film Image finding
960823 occlusal film Image finding
960828 panorex Image finding
• Residual root: 36,46
• Incomplete endodontic Tx: 46
• Metal material filling: 47
970724 panorex Image finding
Residual root: 36,46
Incomplete endodontic Tx: 46
Metal material filling: 47
CT finding 20070824
• A huge low attenuation
mass(3.11cm*3.43cm*3.68cm)is shown in the right submandibular gland.
• Some tiny calcific nodules are found inside of the mass.
• Minimal amorphous enhancement is shown in the mass of the right submandibular gland.
• neck anatomical spaces are essentially clear and preserved.
• Trachea patent without foreign body.
• The bony structure is intact.
• No regional lymph node enlargement could be
identified, but some small visible lymph (<1cm)are found in the submental space.
MRI findings20080731
• lobulated masses involving submandibular and masticator space.
• 3.6*2.9 cm in submandibular space and 2.8*1.6 cm in masticator space.
• these two lesions show iso-intensity on T1-
weighted images and intense high signal intensity on T2-weighted images.
• several signal void nodules within these two lesions are noted,
• the adjacent soft tissue is not infiltrated , the surrounding bony structures are intact.
• above the lesion in the right mandible, the
submandibular gland is displaced upward.
Differential Diagnosis
• Inflammation or neoplasm ?
– Fever or Local heat:unknown
– No purulent drainage was presented – Lymphadenopathy:()
• Duration:3~4 years Îneoplasm tendency
• Benign or malignant neoplasm ?
– Pain: (-)
– Terderness: (-) – Induration: ()
– Lymphadenopathy :() – Facial n. palsy: ()
– Mobility: fixed – Ulceration: ()
– Duration: 3~4 years
Î Benign tendency
working diagnosis
- Hamangioma - Sialolithiasis - Tuberculosis - Foreign body
Our case Hemangioma
gender female female :male=3:1
Age/race 16 y/o Young age/whites
symptom asymptomatic Site Submandibular,
infratemporal space
head and neck
Color ? bright-red ;bluish
consistency soft firm and rubbery
size 5 cm x 5 cm varies
surface smooth smooth
shape dome-shaped nodular or dome
duration 3~4 years 6~10 months
X-ray finding Radiopaque mass Radiopaque mass
Our case Sialolithiasis
gender female -
Age/race 16 y/o Young and middle-
age adult
Symptom asymptomatic Swelling, esp. at meal Site Submandibular,
infratemporal space
Submandibular gland
Color ? ?
consistency soft soft
size 5 cm x 5 cm Varies
surface smooth Smooth
shape dome-shaped Varies
duration 3~4 years Varies
X-ray finding Radiopaque mass Radiopaque mass
Our case Tuberculosis
gender female -
Age/race 16 y/o Young and middle-age adult
Symptom asymptomatic Enlarge of numerous cervical lymph node Site Submandibular,
infratemporal space
Lung, lymphatic system, skin, skeletal system…
Color ? ?
consistency soft -
size 5 cm x 5 cm Varies
surface smooth -
shape dome-shaped Varies
duration 3~4 years Varies
X-ray finding Radiopaque mass Radiopaque mass
Clinical impression
• hemangioma with phleboliths over R’t infratemporal space and submandibular space