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(1)

指導老師:

V.S.:林立民醫師 陳玉昆醫師 王文岑醫師 陳靜怡醫師 Resident:謝牧諺醫師

IntA:郭宗憲 洪裕盛 蔡欣慈 陳怡璇

(2)

Name : 田XX Gender : Male Age : 69

Occupation : 無

Attending V.S. : 謝天渝醫師 First visit : 99. 7. 26

(3)

Referred from 東港安泰 hospital for evaluation of R’t parotid gland tumor.

(4)

This 69 y/o male suffered the episode and had trauma history over R’t face ten years ago. His R’t face started swelling but

sometimes it will decrease. It keeps swelling since five ~ six years ago. Recently, 泰武衛生 所主任 suggested him to go to安泰 hospital for treatment, and Dr. 宋 checked the pano, referred him to our OPD for further

treatment.

(5)

Drug allergy: denied

Systemic disease: hypertension, under medicine control

坐骨神經(?)

Hospitalization: stroke(95年)、盲腸

(6)

OD treatment

Endodontic treatment

Prosthodontic treatment

(7)

Alcohol: (-) Betel nut: (-) Cigarette: (-)

(8)

There is a ovoid shaped swelling mass over right infra-auricular area.

Measured approximately 6x4.7 cm Surface:smooth

Base:sessile Shape:dome

Color:skin surface Consistency:firm

(9)

Fluctuation:(-) Mobility:fixed Pain:(-)

Tenderness:(+) Induration:(-)

Lymphadenopathy:(-)

(10)
(11)

missing tooth:18,15,28,35,36,38,45,46,47 Restoration: 17,16

endodontic condition:21,23,34,44,48 C & B: 14x, 21,26,34,37,44

Post &core: 21,,34,37,44

Lower anterior teeth attrition

(12)
(13)

Pain:(-)

Tenderness:(+)

Duration:5~6 years

No purulent drainage was presented No fever, pain

Inflammation

Step 1-1 →

(14)

Mobility:fixed Fluctuation:(-)

cyst

Neoplasm

Step 1-2

(15)

Features suggestive of benignancy

Features suggestive of malignancy

Movable Fixed

Unattached to skin or mucosa Fixed to overlying skin or mucosa No ulceration of skin or

mucosa

Ulceration of skin or mucosa

Slow growth Rapid growth

Long duration Short duration

No pain Pain often severe

No facial nerve palsy Facial nerve palsy

(16)

Features suggestive of benignancy

Our case

—may be benignancy

Movable Fixed

Unattached to skin or mucosa

Fixed to overlying soft tissue No ulceration of skin or

mucosa

No ulceration of skin or mucosa

Slow growth Slow growth

Long duration 5~6 years

No pain Pain:(-) Tenderness:(+)

No facial nerve palsy Unknown

(17)

The mass is over right cheek (soft tissue origin)

Radiography shows no bone invasion Exophytic dome shape mass

Peripheral

(18)

Inflammation Cyst Neoplasm Malignant Benign

Peripheral Central

Peripheral benign neoplasm

(19)
(20)

Salivary gland origin

→Pleomorphic adenoma

→Oncocytoma

→Warthin tumor

Mesenchymal origin

→Rhabdomyoma

→Neurilemoma

→Neurofibroma

(21)
(22)

Most common salivary neoplasm Usually parotid tumor

A mixture of ductal and myoepithelial element

(23)

Pleomorphic adenoma Our case

Age Any age , most common

between 30~50

69

Gender Slight female predilection Male

Site Usually parotid tumor Right cheek

Size 6 x 4.7 cm

Surface Smooth Smooth

Base Sessile Sessile

Shape Dome Dome

Color Skin surface Skin surface

Consistency Firm Firm

(24)

Fluctuation Pleomorphic adenoma Our case

Pain (-) (-)

Tenderness (-) (+)

Fluctuation (-) (-)

Ulceration (-) (-)

Mobility (-) (-)

Induration (-) (-)

Risk factor Alcohol (-)

Betel quid (-) Smoking (-)

Duration Slowly growing 5~6 years

(25)
(26)

Composed of large epithelial cells as known as oncocyte

A rare neoplasm, representing approximately 1 % of all salivary tumors

(27)

Oncocytoma Our case

Age Any age , Peak in eighth

decade

69

Gender Slight female predilection Male

Site 85%~90% parotid tumor Right cheek

Size Rarely exceed 4 cm 6 x 4.7 cm

Surface Smooth Smooth

Base Sessile Sessile

Shape Dome Dome

Color Skin surface Skin surface

Consistency Firm Firm

(28)

Fluctuation Oncocytoma Our case

Pain (-) (-)

Tenderness (-) (+)

Fluctuation (-) (-)

Ulceration (-) (-)

Mobility (-) (-)

Induration (-) (-)

Risk factor Alcohol (-)

Betel quid (-) Smoking (-)

Duration Slowly growing 5~6 years

(29)

http://www.turkarchotolaryngol.org/p

df/pdf44/pdf44n2/pdf44n2p095.pdf

(30)

a benign neoplasm of the salivary glands

4-15% of salivary gland neoplasms

more common in men during their 6-7th decades

almost exclusively occurs in the parotid gland and bilateral or multifocal tumors

painless swelling, usually within the lower portion of the salivary gland

(31)

Warthin tumor Our case

Age 6th -7thdecades 69

Gender Male predilection Male

Site Tail of Parotid gland,

5-14%bilateral

Right cheek

Size - 8 x 6 cm

Surface Smooth Smooth

Base Sessile Sessile

Shape Nodular Dome

Color Normal skin color Skin surface

Consistency Firm or fluctuant Firm

(32)

Fluctuation Warthin tumor Our case

Pain (-) (-)

Tenderness (-) (+)

Fluctuation (+) (-)

Ulceration (-) (-)

Mobility (-) (-)

Induration (-) (-)

Risk factor Smoking(+) Alcohol (-)

Betel quid (-) Smoking (-)

Duration - 5~6 years

(33)
(34)
(35)

A benign neoplasm of skeletal muscle

Despite the great amount of skeletal muscle throughout the body, benign skeletal muscle tumors are rare

Extracardiac rhabdomyomas show a striking predilection for the head and neck

Can be subclassified into two types

Adult rhabdomyoma

Fetal rhabdomyoma

(36)

Rhabdomyoma Our case Age Adult-Middle-aged and older p’t

Fetal-Young children

69

Gender 70% in men Male

Site Adult-Pharynx, larynx Floor of mouth, soft palate Tongue base

Fetal-Face & periauricular region

Right cheek

Size Can grow to many cm before discovery

6 x 4.7 cm

Surface Smooth Smooth

Base Sessile Sessile

Shape Nodule Dome

Color Relate to adjacent mucosa Skin surface

Consistency Soft Firm

(37)

Fluctuation Rhabdomyoma Our case

Pain Almost(-) (-)

Tenderness Almost(-) (+)

Fluctuation (-) (-)

Ulceration (-) (-)

Mobility (+) (-)

Induration (-) (-)

Risk factor Rare relationship Alcohol (-) Betel quid (-) Smoking (-) Duration Several year-slow growing 5~6 years

(38)
(39)

A benign neural neoplasm of Schwann cell origin

Relatively uncommon, although 25% to 48%

of all cases occur in the head and neck

(40)

Neurilemoma Our case Age Young & middle-aged adult 69

Gender Both Male

Site Almost anywhere in the mouth (Tongue)

Intraosseous (posterior mandible)

Right cheek

Size From a few mm to many cm 6 x 4.7cm

Surface Smooth Smooth

Base Sessile Sessile

Shape Nodular / dome Dome

Color Red Skin surface

Consistency Firm Firm

(41)

Neurilemoma Our case

Pain Almost (-) (-)

Tenderness Almost (-) (+)

Fluctuation (-) (-)

Ulceration (-) (-)

Mobility Movable to fixed (-)

Induration (-) (-)

Risk factor Rare relationship Alcohol (-) Betel quid (-) Smoking (-)

Duration More than one decade 5~6 years

(42)

http://www.kq88.com/kqwk/kq wk01/2007-5/21/155345.htm

(43)

Most common type of peripheral nerve neoplasm

Arise from a mixture of cell types, including Schwann cells and perineural fibroblasts

(44)

Neurofibroma Our case

Age Young adult 69

Gender - Male

Site Skin, tongue & buccal mucosa(oral cavity),bone

Right cheek

Size Small nodule to large mass 6 x 4.7cm

Surface smooth Smooth

Base sessile Sessile

Shape dome Dome

Color Normal skin, red (oral

cavity)

Skin surface

Consistency soft Firm

(45)

Fluctuation Neurofibroma Our case

Pain (-) (-)

Tenderness (-) (+)

Fluctuation (-) (-)

Ulceration (-) (-)

Mobility (-)

Induration (-) (-)

Risk factor (-) Alcohol (-)

Betel quid (-) Smoking (-)

Duration (-) 5~6 years

(46)
(47)

Salivary gland origin

→Pleomorphic adenoma

→Oncocytoma

→Warthin tumor

Mesenchymal origin

→Rhabdomyoma

→Neurilemoma

→Neurofibroma

(48)

Pleomorphic adenoma, over R’t parotid gland

(49)

Oral & maxillofacial pathology, second edition

Difference diagnosis of oral and maxillofacial lesions,

fifth edition

(50)

參考文獻

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原文題目(出處): A Rare Report of Two Cases: Ancient Schwannoma of Infratemporal Fossa and Verocay Schwannoma of Buccal Mucosa(Annals of Maxillofacial Surgery 2017;7;140-2)

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