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(1)

Case Report

指導老師:

V.S.:林立民 陳玉昆醫師 王文岑醫師 Resident: 陳靜怡醫師 謝牧諺醫師 Int :賴彥成 吳美萱 吳筱婷 傅琬茹 日期: 99.03.29

(2)

General Data

Name : 陳建宏

Gender : Male

Age : 25

Occupation : 工人

Attending V.S. : 陳中和醫師

First visit : 99. 2. 24

(3)

Chief Complaint

Refer from 屏基 for checking mandibular expansion and huge radiolucency over mandibular body of radiographic finding.

(4)

Present Illness

This 25 y/o male suffered from lower facial swelling for half a year. He went to LDC

for help, and the doctor suggested him to go to 屏基 for further examination. 屏基

took the X-ray, and a huge radiolucency image was found over mandibular body, then the P`t was suggested to our OMS department for consultation and further examination.

(5)

Past History

Past medical history

 Drug allergy: denied

 Systemic disease: denied

 Herniation (小學時開刀)

Past dental history

 No record

(6)

Risk factors

Alcohol: (-)

Betel nut: (-)

Cigarette: (-)

(7)

Intraoral examination

There are multiple exophytic masses with smooth surface over mandibular buccal and lingual side from tooth 37 to 47

Buccal plate perforation was noted over anterior mandible

Tooth mobility: 36 to 46

(8)

Radiographic examination

There is a well-defined multilocular, soap bubble appearance radiolucent lesion with a corticated margin over mandibular body extending from distal aspect of tooth 47 to mesial aspect of tooth 37, and from inferior mandibular border up to alveolar crest of 36 to 46, measuring approximately 12.2 X 4.3 cm in diameter. Root resorption of tooth 31,32,33,34,35,36,41,42,43,44,45,46, downward displacement of bilateral inferior alveolar canal, and thinning of cortical plate was noted. Loss of lamina dura over tooth 36 to 47.

Impaction: 18, 28, 38, 48

Sinus: clear

TMJ: Unremarkable

(9)

Inflammation ? Cyst ? Neoplasm ?

Infection ?

(10)

Inflammation ? Cyst ? Neoplasm ? Infection ?

Fever or local heat (-)

Color: normal

Pain (-)

No purulent drainage was present

R/O inflammation & infection

Cyst or Neoplasm

(11)

cyst

Developmental Odontogenic

Developmental Inflammatory

Nasolabial cyst Incisive canal cyst Globulomaxillary cyst

Radicular cyst

(12)

Neoplasm

Benign or malignant ?

(13)

1. Movable (except palate)

2. Unattached to skin or mucosa (except palate) 3. No ulceration of skin or mucosa

4. Slow growth, Long duration 5. No pain

6. No facial nerve palsy

7. No bony invasion Features

8. well-defined radiolucency with corticated margin 1. Induration

2. Fixed to overlying skin or mucosa 3. Ulceration of skin or mucosa

4. Rapid growth; growth spurt, Short duration 5. Pain, often severe

6. Facial nerve palsy 7. Bony invasion

8. ill-defined radiolucency without corticated margin

Malignant

Benign

(14)

Peripheral or intrabony origin?

Adjacent mucosa seems normal

appearance Induration:(-) Fluctuation:(-)

Consistency: hard Mobility: fixed

Peripheral

Intrabony

(15)

Odontogenic developmental cyst

Benign intrabony tumor

(16)

Differential diagnosis

Ameloblastoma

Odontogenic keratocyst

Glandular odontogenic cyst

Central giant cell granuloma

(17)

Ameloblastoma

(18)

Our case Ameloblastoma

gender male No sexual predilection

age 25 y/o rare in younger,30~80 y/o

site Mandibular body

(37 to 47)

in mandible, posterior region

swelling (+) (+)

(19)

Our case Ameloblastoma

consistency hard hard

pain (-) (-)

tenderness (-) (-)

induration (-) (-)

LAP (-) (-)

(20)

X-ray finding Our case Ameloblastoma

Border well-defined cortical

boundary

well-defined cortical boundary

Radiodensity radiolucency radiolucency

Effect on surrounding

structures/adjacent teeth

Bony hard swelling, causing root resorption

Buccal and lingual cortical expansion.

Resorption of the roots of teeth.

Teeth may be displaced and become mobile.

Unilocular/

multilocular

Multilocular Multilocular / unilocular

(21)

Odontogenic keratocyst

(22)

Our case Odontogenic keratocyst

gender male A slight male predilection

age 25 y/o from infancy to old age

about 60% found in 10 ~ 40 y/o

site Mandibular body

(37 to 47)

Most in posterior body of the mandible and ramus

swelling (+) (+)

(23)

Our case Odontogenic keratocyst

consistency hard Hard

pain (-) (-) / (+) If larger

tenderness (-) (-)

induration (-) (-)

LAP (-) (-)

(24)

X-ray finding Our case Odontogenic keratocyst

Border well-defined cortical

boundary

well-defined cortical boundary

Radiodensity radiolucency radiolucency

Effect on surrounding

structures/adjacent teeth

Bony hard swelling, causing root resorption

No obvious bone expansion.

Occasionally expand and perforate the bone

Root resorption uncommon Unilocular/

multilocular

Multilocular Unilocular / multilocular

(25)

Glandular odontogenic cyst

(26)

Our case Glandular odontogenic cyst

gender male no predilection

age 25 y/o Most in middle-aged adults

site mandibular body

(37 to 47)

anterior region of the jaw (cross the midline)

swelling (+) (+)

(27)

Our case Glandular odontogenic cyst

consistency hard hard

pain (-) (-) ~ (+)

tenderness (-) (-)

induration (-) (-)

LAP (-) (-)

(28)

X-ray finding Our case Glandular odontogenic cyst

Border well-defined cortical

boundary

well defined with a sclerotic rim

Radiodensity radiolucency radiolucency

Effect on surrounding

structures/adjacent teeth

bony hard swelling, causing root resorption

bony hard swelling, root divergence of the

involved teeth

Unilocular/

multilocular

multilocular Multilocular/ unilocular

(29)

Central Giant Cell Granuloma

(30)

Our case Central giant cell granuloma

gender male female

age 25 y/o 2~80 y/o

60% occur before 30 y/o

site mandibular body

(37 to 47)

anterior region of the jaw (cross the midline)

swelling (+) (+)

(31)

Our case Central giant cell granuloma

consistency hard hard

pain (-) (-) ~ (+)

tenderness (-) (-)

induration (-) (-)

LAP (-) (-)

(32)

X-ray finding Our case Central giant cell granuloma

Border well-defined cortical

boundary

Well-defined generally without a corticated

margin

Radiodensity radiolucency radiolucency

Effect on surrounding

structures/adjacent teeth

bony hard swelling, causing root resorption

bony hard swelling, perforation of the cortical

bone plate, root

resorption in aggressive lesion

Unilocular/

multilocular

multilocular unilocular or multilocular

(33)

Conclusion

1. Ameloblastoma

2. Odontogenic keratocyst

3. Glandular odontogenic cyst 4. Central giant cell granuloma

(34)

Histopathologic report

 Microscopically, it is characterized by fragments of thin odontogenic epithelial lining and fibrous connective tissue. The epithelia lining consists of 6 to 8 layered, cuboid cells. The nuclei of the

basal layer arrange in palisading appearance.

Corrugation and wavy appearance of the lining are also observed. The surface of the lining is

hyperkeratotic. Based upon the above findings, it

shows odontogenic keratocyst.

(35)

Final Impression

Odontogenic keratocyst,

anterior mandible

(36)

Thanks for your attention

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