Oral Examination

(1)

Case 1

Name : 何xx

 Gender : Female

 Age : 12 y/o

 V.S. :

蕭思郁醫師吳崇維醫師

 First visit :

Pedo - 90.10.04 OS - 97.07.11

(2)

Chief Complaint

 Referred from Pedo. Dept to OS OPD for further management of a

radiolucent lesion over right mandibular body.

(3)

Present Illness

 This 12 y/o female patient went to our Pedo OPD on 97.07.11 for oral

examination. Swelling over teeth 43, 44 area and a radiolucent lesion at right mandibular body was noted on

panoramic film. Then she was referred to OS OPD for further treatment.

(4)

Past History

Past Medical History Systemic disease:

1. Ventricular septal defect s/p OP

2. Congenital diaphragmatic hernia s/p repair (85/05/20)

3. mild mental and language delay Drug allergy: denied

 Past Dental History NP

 Personal habit A(-), B(-), C(-)

(5)

Oral Examination

 Swelling at right

mandibular body and symphysis area ( 41- 85)

 Pain(–)

 Tenderness(-)

 Buccolingual bony expansion(+)

 Covering mucosa:

intact

(6)

Panorex 97.09.01

(7)

Clinical Impression

Dentigenous cyst over right

mandibular body and symphysis area

(8)

Treatment Course

 97.09.01

1. Treatment: incisional biopsy, 85 extraction and decompression

2. Findings: bony destruction(+), yellowish clear fluid noted.

 97.11.04 CT

97.12.26 Enucleation under GA

(9)

Microscopic Findings

HP report: dentigerous cyst over impacted 43

(10)

97.09.01 97.10.03

Decompression – 1 month

(11)

97.10.31 97.09.01

Decompression – 2 months

(12)

CT Image 97.11.04

(13)

Skull Film 97.12.16

(14)

Microscopic findings - 1

(15)

Microscopic findings - 2

(16)

Final Diagnosis

 Adenomatoid odontogenic tumor ex dentigerous cyst over right

mandibular body and symphysis area.

(17)

Case 2

 Name: 吳XX

 Gender: Female

 Age: 16 y/o

 VS: 黃逸岳醫師

 Visit Date: 97.07.24 First Visit: 96.08.22

(18)

Chief Complaint

 Painless swelling over right

submandibular area for 4~5 years

(19)

Present Illness

 The 16 y/o female noted a painless, slow growing swelling over right sub-

mandibular for 4~5 years. She had visited OS OPD on 96.08.22. CT exam found a low density mass with dystrophic

calcifications over right submandibular

area. After one year follow up, the swelling became bigger, so further management

was arranged.

(20)

Occlusal Views

960822

960822 960823960823

(21)

CT Image 96.08.24

(22)

Panorex 96.08.28

(23)

Clinical Impression 96.08

 Submandibular area

1. Sialolithiasis and sialoadenitis, right submandibular gland

2. Benign tumor over right submandibular gland

 Infra-temporal area – no record

(24)

Past History

 Past medical history

Systemic disease : denied Hospitalization : denied

Drug allergy: denied

 Past dental history NP

 Personal habit A(-), B(-), C(-)

(25)

Oromaxillofacial Findings 97.07.24

 A painless swelling mass over right sub- mandibular region, about 5.0x3.0 cm in dimension,

(26)

Panorex 97.07.24

(27)

Clinical Impression 97.07

 Submandibular area

1. Sialolithiasis and sialoadenitis, right submandibular gland

2. Benign tumor over right submandibular gland

 Infra-temporal area – no record

(28)

MRI Image 97.07.31

(29)

(30)

Microscopic Findings - 1

(31)

Microscopic Findings - 2

(32)

Final Diagnosis

 Cavernous hemangioma with multiple phleboliths

Salivary gland, Submandibular, Right, Excision

(33)

Case 3

 Name: 蔡XX

 Gender: Female

 Age: 51 y/o

 VS: 陳中和醫師

 Visit Date: 97.10.08 First Visit: 97.01.23

(34)

Chief Complaint

 Fast-growing, exophytic mass over previous surgical site (1 month ago) of right mandibular area

(35)

Present Illness

 The 51 y/o female received

prosthetic treatment (45X47 C&B) a few months ago in LDC. She felt pain over the area and a radiolucent

lesion over apical area of tooth 47

was found. Then she was referred to OS OPD for further treatment on

97.01.23.

(36)

Panorex 97.01.23

(37)

Periapical Film 97.01.23

(38)

Microscopic Findings

^(08-0155)

(39)

HP Report 97.01.23

Cemento-ossifying fibroma Bone, Mandible, Apical 46, Enucleation

(40)

Panorex 97.04.16

(41)

Follow Up – 97.07.09

 Swelling mass over previous operation site.

 Color: red

 Consistency: firm

 Surface: traumatic ulcer

(42)

Panorex 97.07.09

(43)

Microscopic Findings

^(08-1528)

(44)

HP Report 97.07.16

 Cemento-ossifying fibroma

Oral cavity, Edentulous ridge, Lower right, Incision

(45)

Microscopic Findings

^(08-1699)

(46)

Microscopic Findings

^(08-1699)

cont.

(47)

HP Report 97.08.07

 Cemento-ossifying fibroma

Bone, Mandible, Right, Excision

(48)

Panorex 97.09.24

(49)

Past History

(50)

Oral Examination 97.10.08

 Swelling mass over previous operation area

 Color : Gray to white

Surface: necrosis

Consistency:firm

(51)

Panorex 97.10.15

(52)

CT Image 97.10.27

(53)

Microscopic Findings

^(08-2223)

(54)

Microscopic Findings

^(08-2223)

Cellular atypia

Hyperchromatism Pleomorphism

Abnormal mitoses

(55)

Immunohistochemical Stains

^(08-2223)

CD99 (+) S-100 (+)

(56)

HP Report

^(08-2223)

 Ossifying fibromyxoid tumor with malignant change and features of a low-grade osteosarcoma

Bone, Mandible, Right, Excision

(57)

Gross Findings

^(08-2575)

 Tumor size:

ridge: 3.5x3.2x2.0 cm lingual: 4.5x4.0x1.5 cm

 Consistency: firm to wooden hard

 Cortical layer: thinning

(58)

Gross Findings

(08-2575) cont.

(59)

Microscopic Findings

^(08-2575)

(60)

Microscopic Findings

^(08-2575)

Cementum

Osteoid matrix

(61)

Microscopic Findings

^(08-2575)

Cellular atypia

Hyperchromatism Pleomorphism

Abnormal mitoses

(62)

Immunohistochemical Stains

^(08-2575)

CD99 (+) S-100 (+)

(63)

Final Diagnosis

 Ossifying fibromyxoid tumor with malignant change and features of a low-grade osteosarcoma

Bone, Mandible, Right, En bloc resection

(64)

Differential Diagnosis

 Low grade osteosarcoma CD99(-)

 Fibromyxoid sarcoma S-100(-), rosettes

 Fibrosarcoma

 Malignant mixed tumor CD99(-)

(65)

Case 4

 Name :劉吳xx

 Gender : female

 Age : 58y/o

 V.S. : 陳中和醫師

 Visit date: 97.10.28 First visit : 96.05.24

(66)

Chief Complaint

 A recurrent mass over hard palate

(67)

Present Illness

 The 58y/o female found a mass over left palate about 7~8 years ago. She

didn’t felt any discomfort, so she didn’t seek for any treatment. Till she went to

阮綜合 hospital for prosthesis

fabrication, Dr.蔡政峰 noted the mass.

Incisional biopsy was performed on 960409 and the H-P report showed mixed tumor .

(68)

Present Illness

^con’t

 She was referred to our OS OPD on 96/05/24. Conservative excision of tumor was performed on 96.8.11.

After surgery, she was lost follow up till 97.10. The p’t found a mass over the same site so she came to OS

OPD for treatment.

(69)

Oral Examination 96.5.24

 Dimension: 6 x 4 cm

 Color: pink

 Surface: smooth

 Dome shape

 Consistency:

rubbery

Pain: (-)

Tenderness(-)

(70)

Panorex 96.05.24

(71)

CT 96.04.25

(阮綜合hospital)

(72)

Microscopic Findings

96.08.11

(73)

HP Report 96.08.11

 Pleomorphic adenoma over hard palate

(74)

Past History

Past Medical History

Systemic disease: DM, HTN, HBV carrier, stroke(4 yrs ago)

 Past Dental History NP

 Personal habit

A(-), B(-), C(+) 1 pack/day, quit now

(75)

Oral Examination 97.11.12

 Huge protruding mass at left palate ,extending across the midline, 7x 6 cm

 Surface : rough,

ulcerative

 Pain: mild

 Base : pedunculated

 Tenderness(-)

 Consistancey : firm

 Paresthesia over infraorbital nerve

 Nose congestion

(76)

Panorex 97.11.12

(77)

CT Image 97.11.06

(78)

Microscopic Findings 97.11.12

S100(+)

Immunohisto- chemical stain

(79)

Final Diagnosis

 Pleomorphic adenoma, cellular type over hard palate and left maxillary sinus

(80)

Case 5

 Name: 葉XX

 Gender: Male

 Age: 19 y/o

 VS: 沈也雄醫師

 First Visit: 97.06.30

(81)

Chief Complaint

 A swelling mass over R’t cheek for 6 months

(82)

Present Illness

 This 19 y/o male suffered from the painless swelling mass over R’t

cheek for 6 months. He felt pain

when palpating, so he went to ENT dept of 高醫、彰基 hospitals, but the doctors could not make the

impression surely. He came to OS OPD for further evaluation and

treatment.

(83)

Past History

(84)

Oral Examination

 Size: 8 x 7 cm

 Covering mucosa:

intact

 Color: yellowish

 Shape: dome

 Consistency : soft

 Sessile

 Pain(+), mild

 Tenderness(-)

(85)

Panorex

(86)

CT Image

(87)

Clinical Impression

 Lipoma over right cheek

(88)

Microscopic Findings

(89)

Immunohistochemical Stains

S100(+) Ki67(+)

(90)

Final Diagnosis

 Aggressive lipoblastoma over right cheek

(91)

Case 6

 Name: 劉XX

 Gender: Male

 Age: 63 y/o

 VS: 楊家福醫師

 First Visit:

98.02.19

(92)

Chief Complaint

 An exophytic mass over left cheek for 1~2 years

(93)

Present Illness

 This 63 y/o male found an exophytic mass over his left cheek 1~2 years ago. He went to a LDC for treatment and the dentist suggested follow up.

After seeing Dr.李惠娥, he came to OS OPD for further management.

(94)

Past History

Systemic disease : Hepatitis C, HTN, Gout Hospitalization : Acute hepatitis

(95)

Oral Examination

 Size: 2x2 cm

 Covering mucosa intact

 Shape: dome

 Color: pink

 Consistency: firm

 Fixed

 Pain(-), fluctuation(-) tenderness(-)

(96)

Clinical Impression

 Fibroma over left buccal mucosa

(97)

Microscopic Findings

S100(+)

(98)

Final Diagnosis

 Benign lymphoepithelial lesion over left buccal mucosa

(99)

Case 7

 Name: 鄭XX

 Gender: Male

 Age: 50 y/o

 VS: 黃逸岳醫師

 First Visit:

98.03.31

(100)

Chief Complaint

 Referred from 康橋LDC for

management of a swelling mass over hard palate

(101)

Present Illness

 This 50 y/o male suffered from a swelling over hard palate for 2

months. He went to 康橋LDC for

treatment. The dentist suggested him not to wear his RPD and referred him to OS OPD for torus removal.

(102)

Past History

Systemic disease : Hemangioma Hospitalization : denied

 Personal habit

A(+) occasional, B(+) quitted now, C(+) quitted now

(103)

Oral Examination - 1

 Anterior middle hard palate

1. Dimension: 3.5x2 cm 2. Covering mucosa:

intact

3. Color: pink to red 4. Shape: dome

5. Consistency: soft 6. Pain(-)

7. Tenderness(-)

(104)

Oral Examination - 2

 Posterior middle hard palate

1. Dimension: 2.5x2 cm 2. Covering mucosa:

intact

3. Color: pink

4. Shape: lobulated 5. Consistency: bony

hard 6. Pain(-)

7. Tenderness(-)

(105)

Panorex

(106)

Occlusal film

(107)

Clinical Impression

 Anterior hard palate

1. Malignant salivary gland tumor Æ Mucoepidermoid carcinoma

Adenoid cystic carcinoma 2. Lymphoma, Histiocytosis X 3. Malignant soft tissue tumor

 Poterior hard palate Torus palatinus

(108)

Microscopic Findings

(109)

Final Diagnosis

 Adenoid cystic carcinoma over anterior middle hard palate

(110)

CT Image

Origin – minor salivary gland, palate -> sinus or sinus Æ palate

(111)

Case 8

 Name: 黃 XX

 Gender: Male

 Age: 73 y/o

 VS: 王文岑醫師 高郁勛醫師

 First visit: 97.07.09

(112)

Chief Complaint

 Continuous bleeding from right tuberosity for 2 days

(113)

Present Illness

 This 73 y/o male was a case of liver cancer with brain metastasis. A mass over right tuberosity was found due to bleeding when brushing two days ago. He was brought to OM OPD for further treatment.

(114)

Past History

Systemic disease : denied H&N RT: 3 weeks

Drug allergy: aspirin

 Personal habit A(?), B(?), C(?)

(115)

Oral Examination

 Exophytic mass over right tuberosity

 Size: 2.5x1.7 cm

 Color: red

 Surface: rough

 Consistency: rubbery

 Pain(-), induration(-)

(116)

Panorex

(117)

Clinical Impression

 Hepatocellular carcinoma oral metastasis over right tuberosity

 Referred to OS for biopsy

(118)

Microscopic Findings

(119)

Final Diagnosis

 Metastatic carcinoma, suspect HCC

(120)

Case 9

 Name: 楊吳 XX

 Gender: Female

 Age: 59 y/o

 VS: 楊家福醫師

 First visit: 98.02.12

(121)

Chief Complaint

 Painful ulcer over bilateral buccal mucosa and soft palate

(122)

Present Illness

 This 59 y/o female suffered from the above episode for 3 weeks. She had visited several ENT clinic for

treatment, but the lesion did not

subside. She went to a LDC and was suggested to come to OS OPD for

further management.

(123)

Past History

 Past medical history Systemic disease : DM

Surgery : thyroid excision Drug allergy: denied

(124)

Oral Examination

 Massive erosive lesion with white border over bil.

posterior buccal

mucosa, vestibule, retromolar area and soft palate

 Size: 2x1 cm

 Color: red

 Pain(+)

(125)

Clinical Impression

 Lichen planus over bil. buccal

mucosa, vestibule, retromolar area and soft palate

(126)

Microscopic Findings

(127)

Final Diagnosis

 Pemphigus vulgaris over bil. buccal mucosa, vestibule, retromolar area and soft palate

(128)

Treatment Course

 98.02.19referred to 風溼免疫科

1. Lab survey:

WNL

2. Steroids

 98.03.05 OM OPD Æ skin lesion

referred to

dermatology dept.

(129)

Case 10

 Name: 林 XX

 Gender: Male

 Age: 82 y/o

 VS: 王文岑醫師

 Consult date:

97.10.14

(130)

Chief Complaint

 Pain and massive ulcer over upper anterior edentulous ridge and palate for more than 2 months

(131)

Present Illness

 This 82 y/o male admitted to our

hospital due to deep vein thrombosis.

Two months ago, he went to a LDC

and received tooth 22 extraction. The extraction did not heal and massive ulcer started to appear over upper anterior edentulous ridge and soft palate.

(132)

Past History

Systemic disease : deep vein thrombosis under anticoagulation medications

Hospitalization : now Drug allergy: denied

 Personal habit A(?), B(?), C(?)

(133)

Oral Examination

 Massive ulcer over upper anterior ridge, upper lip, and soft palate

 Size: 4x2 cm

 Color: yellowish,

coating with sputum- like material

 Pain(+)

 Multiple removable

white patches over bil.

tongue border

(134)

Clinical Impression

 Granulomatous inflammation over upper anterior ridge and soft palate

 Candidiasis over bil. tongue border

 Consult OS for biospy

 Two smear slides taken Æ candidiasis

(135)

Microscopic Findings

(136)

Final Diagnosis

 TB over soft palate and upper anterior edentulous ridge

 Candidiasis over bil. tongue border