CASE REPORT INTERN H組
指導醫師 : 林立民醫師 陳玉昆醫師 王文岑醫師 陳靜怡醫師 組員 : 顏大祐 郭明融 陳冠憲 陳峙有
GENERAL DATA
Name : 張 X 琴
Sex : 女性
Age : 48
Native : 高雄市
Occupation : 無
Attending V.S. : 黃逸岳醫師
First visit : 99.12.14
CHIEF COMPLAINT
Patient found a hard mass over right maxilla
PRESENT ILLNESS
This 48 y/o female suffered from right maxilla mass. Patient said she found this mass
yesterday (12/13) and she worried about this lesion, so she went to LDC for help. Doctor
there refered her to our OPD.
PAST HISTORY
Past medical history
Denied any systemic disease
Denied any food or drug allergy
Hospitalization (-)
Past dental history
Extraction
Crown(PFM)
Attitude to dental treatment : co-operative
PERSONAL HISTORY
Risk factor related to malignancy
Alcohol (-)
Betel quid (-)
Cigarette (-)
FAMILY HISTORY
Hereditary disease : (-)
Family support : Good support
Chiefly cared by her younger sister
INTRAORAL EXAMINATION
An irregular shaped expansile mass with smooth
surface, sessile base, normal color was found over
buccal gingiva from tooth 13 and 14, measured
about 3.0x3.0cm in diameter, and was bony hard
in consistency.
PHYSICAL EXAMINATION
Mobility : Fixed
Consistency : Bony hard
Pain : (-)
Fluctuation : (-)
Tenderness : (-)
Induration : (-)
Lymphadenopathy : (-)
RADIOGRAPHIC EXAMINATION(PANORAMIC FILM)
There are focal radiopacities in a well-defined unilocular radiolucency with a corticated margin between the tooth 13 to 14 interradicular area, extending from tooth 13 apex area to 14 apex area and from tooth 13 middle third to the floor of nasal cavity, measuring approximately 2.0 x 2.0 cm in diameter.
RADIOGRAPHIC EXAMINATION(PANORAMIC FILM)
Missing : tooth 18 28 36
Filling : tooth 17 16 15 14 24 25 26 27 37 38 47 48
Crown : tooth 45 46
Endodontic treatment : tooth 45 46 (with PAP)
RADIOGRAPHIC EXAMINATION(OCCLUSAL FILM)
Occlusal film showing the
radiolucence with radiopacities
between the tooth 13 to 14 apical area, from middle third of tooth 13 to nasal floor. Root resorption at tooth 14 was also noted.
WORKING DIAGNOSIS
Inflammation? Cyst? Neoplasm?
Fever or local heat (-)
Swelling (+) ---> bony hard swelling
Pain (-)
Normal
Cyst or Neoplasm
WORKING DIAGNOSIS
Central or Peripheral Lesion?
No mucosa lesion
Bone destruction
Central
WORKING DIAGNOSIS
Neoplasm : Benign or Malignant?
Pain (-)
Tenderness (-)
Lymphadenopathy (-)
Ulceration (-)
Induration (-)
Smooth surface
Well-defined radiolucency Benign Tumor
WORKING DIAGNOSIS
Neoplasm
Odontogenic
Ameloblastoma
Nonodontogenic
Central giant cell granuloma
Ossifying fibroma
BENIGN TUMOR
Clinical feature
Smooth surface
Swelling (+)
Color : Normal
Consistency : Bony hard
Fluctuation (-)
Pain (-)
Percussion pain (-)
Tenderness (-)
Induration (-)
Might have bony
expansion
X-ray finding
Focal radiopacities in unilocular radiolucency (RO + RL)
Well-defined with corticated margin
Root resorption
Lamina dura of involvement root disappear
Soap bubble
CONVENTIONAL SOLID AMELOBLASTOMA CENTRAL GIANT CELL GRANULOMA
OSSIFYING FIBROMA
DIFFERENT DIAGNOSIS
Conventional solid ameloblastoma
Central giant cell granuloma
Ossifying fibroma
CONVENTIONAL SOLID AMELOBLASTOMA
CONVENTIONAL SOLID AMELOBLASTOMA
Conventional solid
ameloblastoma Our Case
Age 30~70 45
Site Md. Molar-ramus
(Desmoplastic type:Mx.
anterior)
Mx. anterior
Symptom Painless swelling Swelling (+) Pain (-)
Tenderness (-) Fluctuation (-) Induration (-) Smooth surface Color Bluish to normal Normal
CONVENTIONAL SOLID AMELOBLASTOMA
Conventional solid
ameloblastoma Our Case Margin Well-defined with
corticated Well-defined, with corticated
X-ray feature Uni/multilocular with honeycombed
appearance
Focal radiopacities in radiolucency
Rootresorption + +
Bonyexpansion + +
CENTRAL GIANT CELL GRANULOMA
CENTRAL GIANT CELL GRANULOMA
Central giant cell
granuloma Our Case
Gender Female Female
Age <30(60%) 45
Site Md. anterior Mx. anterior
Symptom Painless swelling Swelling (+) Pain (-)
Tenderness (-) Fluctuation (-) Induration (-) Smooth surface
CENTRAL GIANT CELL GRANULOMA
Central giant cell
granuloma Our Case
Margin Well-defined without
corticated Well-defined, with corticated
X-ray feature Unilocular
(Big - Multilocular) Focal radiopacities in radiolucency
OSSIFYING FIBROMA
OSSIFYING FIBROMA
Ossifying fibroma Our Case
Gender Female Female
Age 20~30 45
Site Md. posterior Mx. anterior
Symptom Painless swelling Swelling (+) Pain (-)
Tenderness (-) Fluctuation (-) Induration (-) Smooth surface
OSSIFYING FIBROMA
Ossifying fibroma Our Case Margin Well-defined with
corticated Well-defined, with corticated
X-ray feature Focal radiopacities in
unilocular radiolucency Focal radiopacities in radiolucency
CLINICAL IMPRESSION
Ossifying fibroma, from maxilla area near nasal floor to gingival margin of tooth 13, between
apex of tooth 13~14
Ameloblastoma, desmoplastic type, from
maxilla area near nasal floor to gingival margin of tooth 13, between apex of tooth 13~14
