Past Medical History Past Medical History

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Case report Case report

報告者報告者: Intern F: Intern F組組

指導醫師指導醫師:口腔病理科全體醫師:口腔病理科全體醫師 報告日期:

報告日期:2007.09.242007.09.24

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General Data General Data

Name : Name : xxxx

Sex : Sex :

Age : 51 Age : 51 y/oy/o

Native : Native : 台灣台灣

Marital status : 已婚Marital status : 已婚

Attending Dr. : Attending Dr. : 陳靜怡陳靜怡 醫師醫師

First visit : 96/08/04First visit : 96/08/04

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Chief Complaint Chief Complaint

zz A swelling mass over A swelling mass over R'tR't hard palate hard palate for 2 weeks

for 2 weeks

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Present Illness Present Illness

zz The 51 The 51 y/oy/o male suffered from above male suffered from above episode two weeks ago. At the same episode two weeks ago. At the same

time, he was on the course of

time, he was on the course of 風濕免疫風濕免疫 therapy in KMU. He asked his KMU

therapy in KMU. He asked his KMU

physician about this problem. Then, his physician about this problem. Then, his

physician referred him to our OPD for physician referred him to our OPD for

further evaluation.

further evaluation.

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Past Medical History Past Medical History

zz

Past Medical History Past Medical History

--Drug allergy : penicillinDrug allergy : penicillin

--Rheumatoid Arthritis: Hospitalization(+) Rheumatoid Arthritis: Hospitalization(+) under medication therapy now

under medication therapy now

--L’L’tt salivary glands tumorsalivary glands tumor which had been which had been treated treated and and tumortumor had been removed in an unknown had been removed in an unknown

Hospital Hospital

--hepatitis B.Chepatitis B.C --DMDM

zz

Past Dental History Past Dental History

-- prosthoprostho -- ODOD

extraction extraction

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Personal History Personal History

zz Oral habits related to malignancyOral habits related to malignancy

-- Alcohol : (Alcohol : (--) ) -- Betel quid : (Betel quid : (--) ) -- Cigarette : (Cigarette : (--))

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Intraoral Examination on 8/4

-- A domeA dome--shaped swelling mass shaped swelling mass with smooth surface, measured with smooth surface, measured

approximately 0.6 x 0.6 cm in approximately 0.6 x 0.6 cm in diameter located between the diameter located between the

midline of hard palate and 1.5cm midline of hard palate and 1.5cm

palatal to tooth 17; posterior to palatal to tooth 17; posterior to

the junction between hard palate the junction between hard palate

and soft palate and soft palate

-- Sessile base , bluish surface Sessile base , bluish surface color

color with soft consistencywith soft consistency -- longlong--span prosthesis from span prosthesis from

21to17 23to27 21to17 23to27

-- Gingival inflammation and Gingival inflammation and swelling of tooth 17

swelling of tooth 17

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Oral &maxillofacial Examination

zz Pain (Pain (--))

z

z Tenderness(Tenderness(--))

zz Swelling (+) Swelling (+)

z

z Fixed (+)Fixed (+)

zz Bleeding tendency (Bleeding tendency (--))

z

z IndurationInduration (?) (?)

zz Fever or local heat (Fever or local heat (--))

z

z LymphadenopathyLymphadenopathy ((--) )

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Radiographic Examination

Radiographic Examination - - periap periap ical ical film film

illill--fitting long span crown fitting long span crown and bridge with distal and bridge with distal

abutment 17 PDL space abutment 17 PDL space widening and suspected widening and suspected incomplete

incomplete endodonticendodontic treatment

treatment

14 to 16

14 to 16 endentulousendentulous area with area with normal alveolar bone

normal alveolar bone resorptionresorption unhealed 14 extraction socket

unhealed 14 extraction socket

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Inflammation or cyst or neoplasm Inflammation or cyst or neoplasm

zz Redness (Redness (--))

z

z Swelling (+)Swelling (+)

zz Fever (Fever (--))

zz Pain (Pain (--))

zz Tenderness (Tenderness (--))

zz FlucturationFlucturation ((--))

z

z Fixed (+)Fixed (+)

zz Bluish (+)Bluish (+)

zz Found the lesion for 2 weeksFound the lesion for 2 weeks

Neoplasm

Neoplasm

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Benign or malignant Benign or malignant

zz Smooth surfaceSmooth surface

zz softsoft

zz Pain (Pain (--))

zz Tenderness (Tenderness (--))

zz IndurationInduration ((--))

zz Fixed (+)Fixed (+)

z

z LAP (+)LAP (+)

Benign

Benign

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zz

Intrabony Intrabony or peripheral or peripheral

zz No evidence of bony destructionNo evidence of bony destruction

z

z Main lesion is a Main lesion is a submucosasubmucosa lesionlesion

peripheral

peripheral

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Inflammation Neoplasm

Benign malignant

1.1. PleomorphicPleomorphic adenomaadenoma 2.2. Warthin`sWarthin`s tumortumor

1.1. MucoepidermoidMucoepidermoid carcinoma carcinoma (low(low-- grade)

grade) 2.2. PLGAPLGA

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Working diagnoses Working diagnoses

1.1. PleomorphicPleomorphic adenomaadenoma

2.2. MucoepidermoidMucoepidermoid carcinoma (lowcarcinoma (low--grade)grade)

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Pleomorphic

Pleomorphic adenoma adenoma Our caseOur case Gender

Gender Female (slight Female (slight predilection) predilection)

malemale

AgeAge Any age(30Any age(30--50y/o)50y/o) 51 y/o51 y/o

SizeSize variablevariable 0.6*0.60.6*0.6 cmcm SiteSite Posterior lateral aspect of Posterior lateral aspect of

palate palate

RRtthard palatehard palate Shape

Shape DomeDome-shaped-shaped Dome-Dome-shapedshaped Margin

Margin Well-Well-defineddefined Well-Well-defineddefined

Pleomorphic

Pleomorphic adenoma adenoma v.s v.s . Our case . Our case

pleomorphic adenoma

Our case

Ps: parotid gland (53-77%)

submandibular gland (44-68%) minor salivary gland (38-43%)

- palate(60%) ,upper lip(20% ) ,buccal mucosa(10%)

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Pleomorphic

Pleomorphic adenomaadenoma Our caseOur case Consistency

Consistency firmfirm SoftSoft

Color

Color normalnormal Blue to reddishBlue to reddish Fever or local heat

Fever or local heat -- --

Lymphadenopathy

Lymphadenopathy -- ++

Fluctuation

Fluctuation -- --

Ulcer

Ulcer +/+/-- (trauma)(trauma) --

PainPain -- --

Induration

Induration -- --

Tenderness

Tenderness -- --

Mobility

Mobility fixedfixed --

Pleomorphic adenoma v.s. Our case

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Pleomorphic

Pleomorphic adenoma adenoma v.s v.s . Our case . Our case

Pleomorphic

Pleomorphic adenomaadenoma Our caseOur case Surface

Surface smoothsmooth SmoothSmooth

Duration

Duration Many month or Many month or

years ,slowly growing years ,slowly growing

found lesion 2 weeks found lesion 2 weeks agoago

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Mucoepidermoid Mucoepidermoid

carcinoma carcinoma

Our case Our case Gender

Gender Slight female Slight female predilection predilection

malemale

AgeAge 22ndnd to 7 to 7 thth decadedecade 51 y/o51 y/o

SizeSize variablevariable 0.6*0.6*0.60.6 cmcm SiteSite Most in parotid gland, Most in parotid gland,

22ndnd in minor salivary in minor salivary gland (hard palate) gland (hard palate)

RRt hard palatet hard palate

Shape

Shape DomeDome-shaped-shaped Dome-Dome-shapedshaped Margin

Margin Well-Well-defineddefined Well-Well-defineddefined Consistency

Consistency Soft to firmSoft to firm SoftSoft Color

Color Blue or red colorBlue or red color Blue to reddishBlue to reddish

mucoepidermoid carcinoma v.s.

mucoepidermoid carcinoma v.s.

Our case Our case

mucoepidermoid carcinoma

Our case

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Mucoepidermoid Mucoepidermoid carcinoma

carcinoma

Our case Our case Fever or local heat

Fever or local heat -- --

Lymphadenopathy

Lymphadenopathy -- ++

Fluctuation

Fluctuation SometimesSometimes -- Ulcer

Ulcer -- --

PainPain -- --

Induration

Induration -- --

Tenderness

Tenderness -- --

Mobility

Mobility -- --

Surface

Surface SmoothSmooth SmoothSmooth

Duration

Duration Aware for the lesion for Aware for the lesion for 1 yr or less

1 yr or less

found lesion 2 weeks found lesion 2 weeks agoago

mucoepidermoid carcinoma v.s.

Our case

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Clinical impression Clinical impression

Pleomorphic adenoma Pleomorphic adenoma

over right hard palate

over right hard palate

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Treatment plan Treatment plan

z

z 96/096/088//0606::

Imp : mucocele by OS doctor Imp : mucocele by OS doctor

Incisional biopsyIncisional biopsy

z

z 96/08/1796/08/17

Arrange CT scanArrange CT scan

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Radiographic Examination

Radiographic Examination - - CT CT coronal view

coronal view ( ( 96.08.20 96.08.20 ) )

This coronal CT image This coronal CT image

showing R't maxillary showing R't maxillary

sinus is filled with sinus is filled with

aovoid

aovoid--shaped shaped

radiopacity substance radiopacity substance

with central with central

calcification , measuring calcification , measuring

about 4x4cm in about 4x4cm in

diameter.

diameter.

No bony destruction No bony destruction

through inferior wall of through inferior wall of

the maxillary sinus the maxillary sinus

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Radiographic Examination

Radiographic Examination - - CT axial CT axial view

view ( ( 96.08.20 96.08.20 ) )

The axial CT image The axial CT image

shows that there is a shows that there is a

polypoid

polypoid--shaped shaped radiopaque within radiopaque within

right maxillary sinus.

right maxillary sinus.

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Radiographic Examination

Radiographic Examination - - CT axial CT axial view in neck

view in neck ( ( 96.08.20 96.08.20 ) )

This axial CT image shows that there are several This axial CT image shows that there are several lymph nodes over bilateral submandibular and lymph nodes over bilateral submandibular and

submental area,measuring about 1cm in diameter submental area,measuring about 1cm in diameter

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Treatment plan

Treatment plan - - cont. cont.

z

z 96/08/2096/08/20

HP report : mucoepidermoid carcinoma, hard HP report : mucoepidermoid carcinoma, hard palate, R

palate, Rtt

zz 96/08/2796/08/27

GA general routineGA general routine

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Radiographic Examination

Radiographic Examination ( ( 96.08.27 96.08.27 ) )

In this film , nothing particular and no bony destruction relative to the lesion found in hard palate. Radiographic burnout is noticed in both side of maxillary area,lower boarder of R't maxillary sinus

drop down than L't side.

Other dental findinds

C&B : 21111213xxx17, 2324xx27, 33x35x,44xx47

RR : 11,12,24 suspected fracture : 24 caries : 42.43

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Treatment plan

Treatment plan - - cont. cont.

z

z 96/09/0296/09/02

-- Operation:Operation:

Hemimaxillectomy, R Hemimaxillectomy, R’tt

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Thanks for your attention

Thanks for your attention

Figure

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References

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