Case Report
Intern G
2011 February
指導醫師:口腔病理科全體醫師
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
Chief Complaint
Tumor mass over right posterior maxilla for a half year
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.
Past Medical History
Systemic disease : denied Drug/food allergy : denied Hospitalization : denied
Past Dental History
Scaling
Operative Dentistry restoration Endodontic tx.
Fixed prosthesis
Attitude to dental treatment:cooperative
Personal Habits
Alcohol drinking (-) Betel nut chewing (-) Cigarette smoking (-)
Denied other specific habits
Physical Examination
A swelling area over upper right molar
region
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
Inflammation Cyst Neoplasm
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
Benign Malignant
Inflammation Cyst Neoplasm
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
Central PeripheralBenign
Inflammation Cyst Neoplasm
Malignant
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
Benign
Central Peripheral
Inflammation Cyst Neoplasm
Malignant
Working Diagnosis
Mixed radiolucent-radiopaque lesion
Odontoma
Ameloblastic fibroodontoma
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Odontoma
Developmental anomalies
Consist chiefly enamel and dentin
Most common types of odontogenic tumor May prevents eruption of tooth
Simple local excision
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
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
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
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
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
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
Calcifying epithelial odontogenic tumor
Pindborg tumor
Its origin is uncertain
Conservative local resection Recurrent rate:15%
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
Working diagnosis
Ameloblastic fibroodontoma Odontoma(complex)
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clinical impression
Ameloblastic fibrodontoma, right posterior maxilla