Case Report

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 H：吳政榮 洪欣儀 廖建智 黃永舜 日期: 99.05.24

General Data

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Chief Complaint

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Present Illness

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months. He went to LDC for periodontal treatment but in vain. So, the dentist

suggested him come to our OPD for further examination and treatment.

Past History

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 Drug allergy: denied

 Systemic disease: H/T

 Hospitalization: Acute pancreative

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 Extraction

 Periondotal treatment

Risk factors

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30 yrs, 1 caps/day, quit for 2 weeks

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30 yrs, 2 packs/day, quit for 2 weeks

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30 yrs, 3 packs/day, persist

Intraoral examination

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surface , dome shape in red color and firm consistency swelling on right lower

premolar vestibule area. He felt pain and an induration on the lesion area. Also,

there is a lymphadenopathy on the right lower jaw angle.

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Radiographic examination

 There is an ill-defined radiolucent lesion without a corticated margin over right mandibular body extending from distal aspect of tooth 42 to mesial aspect of tooth 47, and from inferior mandibular border up to alveolar crest of 43 to 47, measuring approximately 12 X 4 cm in diameter. Floating tooth on 44, 45.

 Missing: tooth 35, 36, 37,47

 Sinus: clear

 TMJ: Unremarkable

Inflammation ? Cyst ? Neoplasm ?

Infection ?

Inflammation ? Cyst ? Neoplasm ? Infection ?

 Fever or local heat (-)

 Swelling (+)

 Color: reddish

 Pain (+)

 No purulent drainage was present

 Mixed RL/RO

 Well-defined corticated margin(-)

 Moth-eaten border

 LAP(+)

R/O infection cyst

 inflammation & Neoplasm

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

Radiographic bony invasion Induration: (+)

Fluctuation: (-)

Consistency: firm Mobility: fixed

Peripheral

Intrabony

 Inflammation

 Malignant intrabony tumor

Working differential diagnosis

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Chronic Osteomyelitis

Our case Chronic Osteomyelitis

gender Male 75% male

age 49 y/o All age

site Mandibular body Mandible

swelling (+) (+)

Our case Chronic Osteomyelitis

pain (+) (+)

LAP (+) -

inflammation (+) ⁽⁺⁾

sinus (-) (+)

X-ray finding Our case Chronic Osteomyelitis

Border Ill-defined

moth-eaten

Ill-defined moth-eaten

Radiodensity Mixed RO/RL RL/RO

Effect on surrounding

structures/adjacent teeth

Floating tooth Tooth loose

Pathologic fracture Sequestrum formation

Squamous cell carcinoma

Our case SCC

gender Male Male

age 49 y/o > 65 y/o

site Mandibular body Intraoral, especially tongue

swelling (+) (+)

Irregularly exophytic lesion

ABC (+) (+)

Our case SCC

consistency Firm -

pain (+) Gingiva/alveolar site (-)

tenderness (+) (+)

induration (+) (+)

LAP (+) (+)

X-ray finding Our case SCC

Border Ill-defined moth-eaten boundary

Moth-eaten RL with ragged margin

Radiodensity Mixed RO/RL RL

Effect on surrounding

structures/adjacent teeth

Floating tooth Bony destruction Tooth mobility

Intraosseous mucoepidermoid

carcinoma

Our case IMC

gender Male Female

age 49 y/o Mid age

site Mandibular body Mandible

pain (+) Less frequency

swelling (+) (+)

X-ray finding Our case IMC

Border Ill-defined moth-eaten boundary

Well-defined

Radiodensity Mixed RO/RL RL

Effect on surrounding

structures/adjacent teeth

Floating tooth Irregular bony destruction

Massive osteolysis

Our case MO

gender male /

age 49 y/o 70y/o

site Mandibular body mandible

pain (+) (+)

swelling (+) (+)

X-ray finding Our case MO

Border Ill-defined moth-eaten boundary

Poor-defined

Radiodensity Mixed RO/RL RL

Effect on surrounding

structures/adjacent teeth

Floating tooth Mobile teeth, Malocclusion, Bone destruction

Osteosarcoma

Our case osteosarcoma

age 49 y/o 10-20 y/o

site Mandibular body Maxilla=mandible (post. body)

pain (+) Pain

swelling (+) (+)

X-ray finding Our case Osteosarcoma

Border Ill-defined moth-eaten boundary

Ill-defined

Radiodensity Mixed RO/RL RO

Effect on surrounding

structures/adjacent teeth

Floating tooth Loosen of tooth PDL widening

Clinical impression

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Thank you for your

attention!