Case report Case report
Int. D 組
General Information General Information
Name: 薛X X Gender: male Age: 39
Marital status: married Native: 高雄縣
First visit : 95/09/27
Chief Complaint Chief Complaint
A huge mass over right palatal side for more
than 10 years.
Right upper posterior toothache recently.
Present Illness Present Illness
This 39 y/o male patient found a huge, painless mass for more than 10 years. At the beginning, he did not notice its size, but he felt it was
growing larger gradually.
Recently he had toothache last week and went to LDC for help. The dentist suggested him to visit our OPD for further examination.
95/09/27 First visit at our OPD.
Intraoral Finding Finding
Focal ulceration on surface Firm in consistency
Tenderness (-) Induration (+)
Crossing midline and soft palate involvement Tooth 17 mobility gradeⅡ
Tooth 16、27、36、47 restoration
Past Past History History
Past medical history
Denied any major systemic diseases.
Denied any food or drug allergies.
Hospitalization history（＋）due to
appendectomy long time ago（＞20 years）
Past dental history
Attitude to dental treatment: acceptable.
Personal Oral Oral Habits Habits
1 bottle/day for 10 years, beer Persisted until now
Betel quid (＋) :
10 grains/day for 4~5 years Quitted 2 years ago.
Smoking (＋) :
1PPD/day for 15 years.
Persisted until now
Missing tooth: 37 、46 、48
Filling: 16(MO)、27(O)、36(O)、47(O) Sinus: right sinus floor elevated
Tooth 38 mesial tilting Tooth 18 elongation
Angular bony defect: tooth 17 Horizontal bony defect
Fever or local heat (-)
Slow-growing mass (10年)
Tenderness (-) Numbness (-) Induration(-)
Differential Diagnosis Differential Diagnosis
Working Diagnosis Working Diagnosis
1. Pleomorphic adenoma 2. Basal cell adenoma 3. Canalicular adenoma 4. Schwannoma
6. Mucoepidermoid carcinoma
7. Polymorphous low grade adenocarcinoma 8. Acinic cell carcinoma
Pleomorphic Adenoma Adenoma (Benign mixed tumor) (Benign mixed tumor)
53%~77% of salivary gland tumors Slow-growing, painless, firm mass Usually age 30-50 (young adults) Facial palsy & pain are rare
Palate is the most common site for minor gland mixed tumor
Basal cell adenoma Basal cell adenoma
Slow-growing, painless, free movable mass Parotid (75%) 1st, minor gland 2nd
Female (female: male =2:1 in some study)
Can be at any aged, middle-aged (older adults), 61~70 (most)
Most less than 3 cm in diameter
Canalicular adenoma adenoma
Slow-growing, painless, freely movable mass
Usually older adults, 61~70 (most) 大小從幾公釐到2公分不等
Upper lips (73.5%)
Benign neural neoplasm
Slow-growing, asymptomatic (although
tenderness or pain may occur in some instances ) Most common in young and middle-age adults Few millimeters to several centimeters in size
The most common location is tongue (cancer can occur almost anywhere in the mouth)
On occasion, the tumor arises centrally within bone and may produce bony expansion.
Benign neural neoplasm Slow-growing, painless
Size from small nodules to larger masses
Skin is the most frequent location (but lesions of oral cavity are not uncommon ) Tongue and buccal mucosa are the most common intraoral sites.
Mucoepidermoid carcinoma carcinoma
Many years duration Asymptomatic
Made of 15% to 20% minor gland tumors Broad age range (2nd to seventh decades)
The most common malignant salivary gland tumor.
Slight female predilection
Pain or facial nerve palsy may develop (Although many year duration)
P P olymorphous low grade olymorphous low grade adenocarcinoma
Present for a long time with slow growth Almost in minor salivary gland
65% on soft and hard palate
Sometimes bleeding and uncomfortable Infiltrate underlying bone
Acinic cell cell adenocarcinoma adenocarcinoma
Slowing growing mass
Asymptomatic (pain and tenderness sometimes report) Act in a non-aggressive fashion
9% develop in the oral minor salivary glands (buccal mucosa, lips, palate being the most common sites)
Broad age range (2nd to 7th decades), mean age is 40
Malignant salivary gland tumor Women to men: 3:2
Clinical impression Clinical impression
Pleomorphic adenoma, right palate
There is a well-defined
homogeneous soft tissue mass
over the right palate. The lesion is measured about 4*4 cm in
maximum diameter. The lesion
border extends from right alveolar bone to left palate, and from right premolar area to retromolar area.
The adjacent bony structure show prominent impression with mild scalloping and preserved cortices
There is a huge well-demarcated nearly homogeneous soft tissue mass (3.96cm x 3.81cm x 2.96cm) located over the right aspect of the hard palate.
The adjacent bony structure show prominent
impression with mild scalloping and preserved cortices.
Multiple enlarged lymph nodes (>1cm) in the bilateral submandibular spaces.
Multiple small lymph nodes (<1cm) in the submental, the bilateral submandibular, and the posterior cervical spaces.
Lateral view view
The calvarium is intact.
The sella turcica is not enlarged.
Class I malocclusion
PA PA view view
No nasal septal deviation is noted.
Water ’ ’ s s view view
The bony structures of the orbits and
sinuses are intact.
Mucosal thickening of right maxillary sinus is present.
Mild chronic right maxillary sinusitis.