• 沒有找到結果。

Case report

N/A
N/A
Protected

Academic year: 2022

Share "Case report "

Copied!
22
0
0

加載中.... (立即查看全文)

全文

(1)

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

(2)

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

(3)

Chief complaints

• Swelling over right submandibular area for about 4 years.

(4)

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

(5)

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

(6)

Personal history

• Alcohol(-)

• Betel quid(-)

• Cigarette (-)

(7)

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: (-)

(8)

960822 occlusal film Image finding

(9)

960823 occlusal film Image finding

(10)

960828 panorex Image finding

• Residual root: 36,46

• Incomplete endodontic Tx: 46

• Metal material filling: 47

(11)

970724 panorex Image finding

Residual root: 36,46

Incomplete endodontic Tx: 46

Metal material filling: 47

(12)

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.

(13)

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.

(14)

Differential Diagnosis

(15)

• Inflammation or neoplasm ?

– Fever or Local heat:unknown

– No purulent drainage was presented – Lymphadenopathy:(­)

• Duration:3~4 years Îneoplasm tendency

(16)

• Benign or malignant neoplasm ?

– Pain: (-)

– Terderness: (-) – Induration: (­)

– Lymphadenopathy :(­) – Facial n. palsy: (­)

– Mobility: fixed – Ulceration: (­)

– Duration: 3~4 years

Î Benign tendency

(17)

working diagnosis

- Hamangioma - Sialolithiasis - Tuberculosis - Foreign body

(18)

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

(19)

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

(20)

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

(21)

Clinical impression

• hemangioma with phleboliths over R’t infratemporal space and submandibular space

(22)

Thanks for your attention!

參考文獻

相關文件

congenital basal cell adenoma, basaloid adenoma, congenital hybrid basal cell adenoma, and adenoid cystic carcinoma. basal cell adenoma 1~2% in

Aim: The aim of this report is to present a case of multiple calcified tuberculous lymph nodes found in a panoramic radiograph including a discussion of the differential diagnosis

4 Sialoliths developing in the hilus of the submandibular gland tend to be oval and may grow larger before becoming symptomatic reflecting the dynamics of fluid flow around

(1) Swelling (2) Anatomical asymmetry (3) Residual glandular swelling (4) Size fluctuation, usually rapid onset and partial resolution over several hours (5)

— Miloro and Quinn advocate dividing multifocal central giant cell lesions into synchronous or metachronous lesions: metachronous lesions are more likely to represent a

Liao CT, Chang JT, Wang HM, Ng SH, Hsueh C, Lee LY, Lin CH, Chen IH, Huang SF, Cheng AJ, Yen TC: Preoperative [18F] fluorodeoxyglucose positron emission tomography standardized

Fig. 3 MR images of the mandible. a T1-weighted MR image showing a decrease in the signal intensity of the bone marrow in the left lower premolar and molar regions, except for

In this case report an extreme case of severe multiple idiopathic cervical root resorption in a healthy young adult male, involving every tooth and leading to the loss of 14