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
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. 24Chief Complaint
Refer from 屏基 for checking mandibular expansion and huge radiolucency over mandibular body of radiographic finding.Present Illness
This 25 y/o male suffered from lower facial swelling for half a year. He went to LDCfor 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.
Past History
Past medical history Drug allergy: denied
Systemic disease: denied
Herniation (小學時開刀)
Past dental history No record
Risk factors
Alcohol: (-)
Betel nut: (-)
Cigarette: (-)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 46Radiographic 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
:
Inflammation ? Cyst ? Neoplasm ?
Infection ?
Inflammation ? Cyst ? Neoplasm ? Infection ?
Fever or local heat (-)
Color: normal
Pain (-)
No purulent drainage was present
R/O inflammation & infection
Cyst or Neoplasm
cyst
Developmental Odontogenic
Developmental Inflammatory
Nasolabial cyst Incisive canal cyst Globulomaxillary cyst
Radicular cyst
Neoplasm
Benign or malignant ?
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
Peripheral or intrabony origin?
Adjacent mucosa seems normal
appearance Induration:(-) Fluctuation:(-)
Consistency: hard Mobility: fixed
Peripheral
Intrabony
Odontogenic developmental cyst
Benign intrabony tumor
Differential diagnosis
Ameloblastoma
Odontogenic keratocyst
Glandular odontogenic cyst
Central giant cell granulomaAmeloblastoma
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 (+) (+)
Our case Ameloblastoma
consistency hard hard
pain (-) (-)
tenderness (-) (-)
induration (-) (-)
LAP (-) (-)
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
Odontogenic keratocyst
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 (+) (+)
Our case Odontogenic keratocyst
consistency hard Hard
pain (-) (-) / (+) If larger
tenderness (-) (-)
induration (-) (-)
LAP (-) (-)
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
Glandular odontogenic cyst
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 (+) (+)
Our case Glandular odontogenic cyst
consistency hard hard
pain (-) (-) ~ (+)
tenderness (-) (-)
induration (-) (-)
LAP (-) (-)
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
Central Giant Cell Granuloma
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 (+) (+)
Our case Central giant cell granuloma
consistency hard hard
pain (-) (-) ~ (+)
tenderness (-) (-)
induration (-) (-)
LAP (-) (-)
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
Conclusion
1. Ameloblastoma
2. Odontogenic keratocyst
3. Glandular odontogenic cyst 4. Central giant cell granuloma