CASE REPORT

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Intern J組卓逸德葉育君顏丞偉黃靜瑜

指導醫師：

口腔病理診斷科全體醫師

2011/06/30

CASE REPORT

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 Name：余XX

 Chart No.：09xxxx31

 Gender：女

 Age：47

 Occupation：家管

 Date of first visit：100/05/25

 First visit V.S.：Dr. 陳中和

PERSONAL DATA

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 Referred from LDC due to intrabony cyst-like lesion over right mandibular body

CHIEF COMPLAINT

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 This 47 y/o female visited LDC for pain over R’t mandibular area and received panoramic examination finding an

intrabony cyst-like lesion on 100.05.23. Therefore, the dentist suggested the patient to come to our OPD for further

examination and treatment.

PRESENT ILLNESS

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 Systemic disease：denied

 Drug / food allergy：denied

 Hospitalization：denied

PAST MEDICAL HISTORY

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 Routine dental care

PAST DENTAL HISTORY

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 Alcohol drinking：nil

 Betel nut chewing：nil

 Cigarette smoking：nil

 Denied other specific habits

PERSONAL HABITS

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 Size：2.5x1.5 cm in max. diameter

 Surface：smooth

 Shape：dome

 Color：normal mucosa

 Consistency：hard

 Pain：(+)

 Tenderness：(+)

 Induration：unknown

 Fluctuation：(-)

 Lymphadenopathy：(-) , non-mentioned particular LN

 Missing：tooth 46, 47

INTRA-ORAL EXAMINATION

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 There is a well-defined multilocular radiolucency with a

sclerotic margin over R’t posterior mandibular body, extending from distal aspect of tooth 45 to anterior aspect of R’t

mandibular ramus and from R’t mandibular alveolar ridge down to the inferior border of R’t mandibular body, downward

displacing and destroying the superior border of R’t mandibular canal, measuring approximately 3.5×3 cm in diameter. This

lesion causes external root resorption of tooth 45, crown & root resorption and displacement of tooth 48.

PANORAMIC EXAMINATION

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 Peg tooth：tooth 12

 Rotation：tooth 22

 Attrition：teeth 23, 41

 Embedded：tooth 18

 Impaction：tooth 38

 Missing：tooth 28, 46, 47

 Dental midline – lower shift to R’t side 2 mm

RADIOGRAPHIC EXAMINATION

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DIAGNOSTIC SEQUENCE

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INFLAMMATION? INFECTION? NEOPLASM &

CYST?

Our case Inflammation Infection Neoplasm Cyst

Color Normal Red Red Variable Normal

Fever or

local heat

- + + - -

Pain

+ + + +/- +/-

Consistency Hard Rubbery Firm Variable Soft

Fluctuation

- - -

^Variable

+/-

Discharge

- + + +/- -

Ulceration

- - - +/- -

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Our case Benign Malignant X-ray margin Well-defined Well-defined Poor-defined

Mobility Fixed Fixed Fixed

LAP

- - +

MALIGNANT? BENIGN?

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 Neoplasm

 Odontogenic

 Conventional solid ameloblastoma

 Odontogenic myxoma

 Nonodontogenic

 Central giant cell granuloma

 Intrabony vascular malformation

 Cyst

 Odontogenic keratocyst (Keratocystic odontogenic tumor)

WORKING DIAGNOSIS

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CONVENTIONAL SOLID AMELOBLASTOMA

Our case Conventional solid

ameloblastoma

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Our case Conventional solid ameloblastoma

Age 47 y/o 30 ~ 70 y/o

Gender Female Not significant

Site R’t posterior mandibular body 80~85% occur in the mandibular molar ascending area

Size 3.5 x 3.0 cm Non-mentioned

Duration Unknown Slow-growing

Base Sessile Sessile

Color Normal mucosa Normal mucosa

Shape Dome Non-mentioned

Surface Smooth Smooth

Consistency Hard Bony hard

Pain + -

Tenderness + -

Mobility Fixed Fixed

Induration Unknown Non-mentioned

CLINICAL COMPARISON

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X-RAY FINDING COMPARISON

Radiodensity Well-defined multilocular, soap bubble radiolucency

Well-defined uni/multilocular with honeycombed or soap bubble radiolucency Margin Corticated margin Corticated margin

Effects on Surrounding

structures

Downward displacing mandibular canal and crown & root resorption and

displacement of tooth 48

Root resorption and tooth displacement

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ODONTOGENIC MYXOMA

Our case Odontogenic myxoma

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Our case Odontogenic myxoma

Age 47 y/o Average 25 to 30 y/o

Gender Female Non significant

Site R’t posterior mandibular body Any area of the mandible

Color Normal mucosa Normal mucosa

Shape Dome Dome

Consistency Hard Gelatinous

Pain + -

Tenderness + -

Mobility Fixed Non-mentioned

Induration Unknown Now-mentioned

COMPARISON

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Radiodensity Well-defined multilocular, soap bubble radiolucency Well-defined honeycombed radiolucency Margin Corticated margin Corticated margin

structures

Scallops between the roots of adjacent tooth and without bone expansion and no

root resorption

X-RAY FINDING COMPARISON

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CENTRAL GIANT CELL GRANULOMA

Our case Central giant cell

granuloma

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Our case Central giant cell granuloma

Age 47 y/o 2 – 80 y/o, 60% <30 y/o

Gender Female Female

Site R’t posterior mandibular body 70 % mandible and cross the midline

Color Normal mucosa Blue, purple

Shape Dome Dome

Consistency Hard Non-mentioned

Pain + -

Tenderness + +

Mobility Fixed Non-mentioned

CLINICAL COMPARISON

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Radiodensity Well-defined multilocular, soap bubble radiolucency Well-defined uni/multilocular radiolucency Margin Corticated margin Noncorticated margin

structures

Tooth resorption / displacement and downward displacing mandibular canal

X-RAY FINDING COMPARISON

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INTRABONY VASCULAR MALFORMATION

Our case Vascular Malformation

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Our case Vascular Malformation

Age 47 y/o 0 ~ 20 y/o

Gender Female Female

Site R’t posterior mandibular body Mandibular

Size 3.5 x 3.0 cm > 4 cm

Duration Unknown Non-mentioned

Color Normal mucosa Normal mucosa, red

Shape Dome Dome

Pain + -

Tenderness + -

Mobility Fixed Fixed

CLINICAL COMPARISON

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Radiodensity Well-defined multilocular, radiolucency

Well-defined maltilocular honeycombed of soap-bubble radiolucency

Margin Corticated margin Noncorticated margin Effects on

Surrounding structures

Sun-burst appearance / cortical expansion / mandibular canal

enlargement

X-RAY FINDING COMPARISON

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ODONTOGENIC KERATOCYST

Our case Odontogenic Keratocyst

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Our case Odotogenic keratocyst

Age 47 y/o 10 ~ 40 y/o (60%)

Gender Female Male

Site R’t posterior mandibular body Mandibular posterior region (60~80%)

Duration Unknown Non-mentioned

Color Normal mucosa Normal mucosa, red

Shape Dome Dome

Pain + +

Tenderness + Non-mentioned

Mobility Fixed Movable

CLINICAL COMPARISON

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Radiodensity Well-defined multilocular, radiolucency Well-defined unilocular radiolucency Margin Corticated margin Corticated margin

structures

Less adjacent tooth root resorption and 25% ~ 40% contain impacted tooth

X-RAY FINDING COMPARISON

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 Conventional solid ameloblastoma over R’t posterior mandibular body and tooth 48 contained

 Odontogenic keratocyst over R’t posterior mandibular body and tooth 48 contained

CLINICAL IMPRESSION

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 Brad W. Neville, Douglas D. Damm, Carl M. Alien, Jerry E.

Bouquot. Oral and maxillofacial pathology, 3^rd ed. St. Louis, MO: Saunders; 2009.

 Norman K. Wood, Paul W. Goaz. Differential Diagnosis of Oral and Maxillofacial Lesions, 5^th ed. St. Louis, MO: Mosby; 1997.

 Stuart C.White, Michael J.Pharoah. Oral Radiology: Principles and Interpretation, 6^th ed. St. Louis, MO: Mosby; 2009.

REFERENCES

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