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(1)

Case Report

Intern G

2011 February

指導醫師:口腔病理科全體醫師

(2)

Personal Data

Name:陳XX

Chart No. :2xxxxxx1 Gender:male

Age: 15 y/o

Occupation : Student

Address : 高雄市左營區 Date of first visit : 99/10/26 Attending V.S. : 黃逸岳 醫師

(3)

Chief Complaint

Tumor mass over right posterior maxilla for a half year

(4)

Present Illness

This 15 y/o male suffered from a swelling over right posterior maxilla for more than half a year. He went to LDC for help. The doctor suggested him to the hospital for examination. He went to 高榮 for X-ray

examination and biopsy. Then, her mother took him to see Dr. 洪堅銘 who suggested him to visit KMU OS OPD for further

treatment.

(5)

Past Medical History

Systemic disease : denied Drug/food allergy : denied Hospitalization : denied

(6)

Past Dental History

Scaling

Operative Dentistry restoration Endodontic tx.

Fixed prosthesis

Attitude to dental treatment:cooperative

(7)

Personal Habits

Alcohol drinking (-) Betel nut chewing (-) Cigarette smoking (-)

Denied other specific habits

(8)

Physical Examination

A swelling area over upper right molar

region

(9)

Panorex finding

Bridge:11-21

Impaction:17, 28, 38, 48 Lower anterior crowding

Filling(resin):16,26,36,46 Endodontic treatment:46

Rotation: 43

Radioaque lesin: 36 distal root

(10)

Inflammation Cyst Neoplasm

(11)

Our case Inflammation Cyst Neoplasm

Color Normal Red Normal Variable

Discharge - + - -

Consistency Firm Rubbery Soft Firm

Pain - + - +/-

Ulceration - - - +/-

Mobility Fixed Fixed Fixed Fixed

Duration A half year Days Years Months

(12)

Benign Malignant

Inflammation Cyst Neoplasm

(13)

Our case Benign Malignancy

Surface Smooth Smooth Rough

Ulceration - - +

X-ray margin Well-defined Well-defined Poor-defined

Mobility Fixed Movable Fixed

Lap - - +

Duration Half a year Years Months

(14)

Central PeripheralBenign

Inflammation Cyst Neoplasm

Malignant

(15)

Our case Central Peripheral

Consistency Firm Firm Rubbery

Ulceration - +/- +/-

Induration - - +

X-ray border Well-defined Well-defined Il-defined Bony

expansion or perforation

+ +/- +

Mobility Fixed Fixed Fixed

(16)

Benign

Central Peripheral

Inflammation Cyst Neoplasm

Malignant

(17)

Working Diagnosis

Mixed radiolucent-radiopaque lesion

Odontoma

Ameloblastic fibroodontoma

Adenomatoid odontogenic tumor

Calcifying epithelial odontogenic tumor

(18)

Odontoma

Developmental anomalies

Consist chiefly enamel and dentin

Most common types of odontogenic tumor May prevents eruption of tooth

Simple local excision

(19)

Comparison

Our case Odontoma(compound)

Gender M Both(1:1)

Age 15 5~20(14)

Site Upper right posterior

area Anterior maxilla

Pain - -

Ulcer - -

LAP - -

Consistency Firm Firm

Shape Well-defined Well-defined

Features

Radiopaque, smooth contours,

with uneruped tooth

Composed of

multiple, small tooth like structure

(20)

Comparison

Our case Odontoma(complex)

Gender M Both(1:1)

Age 15 5~20(14)

Site Right posterior maxilla Molar region

Pain - -

Ulcer - -

LAP - -

Consistency Firm Firm

Shape well-defined well-defined

Features

Radiopaque, smooth contours, with unerupted

tooth

Consists of a conglomerate of enamel and dentin

(21)

Adenomatoid odontogenic tumor

Arised from remnants of dental lamina or enamel organ epithelium

Largely limitied to younger patient

Seldom exceed 3.0 cm in greatest diameter Usually appear as small, sessile masses on the facial gingival of the maxilla

Tx:Enucleation

(22)

Comparison

Our case AOT

Gender M F:M = 2:1

Age 15 16.5

Site Right posterior maxilla Anterior jaw

Pain - -

Ulcer - -

LAP - -

Consistency Firm Firm

Shape Well-defined Well-defined

bony expansion + +

Features Radiopaque, smooth contours, with unerupted

tooth

Unilocular RL

involved the crown of an unerupted

tooth

(23)

Ameloblastic fibrodontoma

Appear as a developing odontoma

Progressive growth, causing deformity and bony destruction

Some may appear as largely calcified masses with only a narrow rim of RL

Conservative curretage

(24)

Comparison

Our case AF

Gender M no predilection

Age 15 10

Site Right posterior maxilla Posterior jaw

Pain - -

Ulcer - -

LAP - -

Consistency Firm Firm

Shape Well-defined Well-defined

Features

Radiopaque, smooth contours,

with unerupted tooth

Unilocular, or rarely, multilocular RL

contain with

calcified material and an uneruped

tooth

(25)

Calcifying epithelial odontogenic tumor

Pindborg tumor

Its origin is uncertain

Conservative local resection Recurrent rate:15%

(26)

Comparison

Our case CEOT

Gender M No predilection

Age 15 30-50

Site Right posterior maxilla posterior jaw

Pain - -

Ulcer - -

LAP - -

Consistency Firm Firm

Shape Well-defined Well-defined

Features

Radiopaque, smooth contours, with unerupted

tooth

Unliocular or multilocular radiolucent image , but

may contain calcified structure of varying size

and density

(27)

Working diagnosis

Ameloblastic fibroodontoma Odontoma(complex)

Adenomatoid odontogenic tumor

Calcifying epithelial odontogenic tumor

(28)

Clinical impression

Ameloblastic fibrodontoma, right posterior maxilla

(29)

Thanks for listening

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