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1 口診 SEMINAR 第八組指導老師 : 陳玉昆醫師

2 組員名單吳筱婷許凰瑩容佳珮吳美萱謝旻芸張紫陽黃立安張庭維廖昱豪吳政榮

3 General data Name: case 4 Chart No: XXXXXXX Sex: male Age: 35 y/o Native:Taiwan Marriage: No Occupation: Labor

4 Chief complaint A mass over lower left buccal region for 3 months.

5 Present illness The 35 y/o male found a mass over left lower buccal vestibule for 3 months. He felt a little numbness over lingual g side when touched by tongue tip.

6 Extraoral examination Profile: straight Lymphadenopathy: (-)

7 Intraoral examination There is a dome- shaped swelling located on attached gingiva between 33 &34 buccal area.

8 Intraoral examination There is a little swelling over the lingual of tooth The adjacent mucosa seemed to be normal.

9 Intraoral examination Size:1*0.8*0.4 cm 3 Base: sessile Color :normal Consistency: hard Pain: (-) Tenderness: (-) Mobility: fixed on bone Induration:(-) Tooth vital test:(+)

10 Intraoral examination Peg teeth: tooth Plaque or calculus deposition Lower teeth crowding

11 Past medical history Denied any systemic disease Denied any allergic reaction Denied any hospitalized history Past Dental History Denied any dental treatment Attitude to dental treatment:acceptable

12 Personal habits Risk factors related to malignancy: Alcohol drinking: (-) Betel-quid chewing: (-) Cigarette smoking: (-) Others: Denied other specific oral habits

13 Panoramic finding Panoramic showed an well-defined unilocular round-shaped radiolucency with a corticated margin between the root of tooth33 34

14 Panoramic finding Extending from the apical third down to the apex of tooth33 34 and from the distal side of the tooth 33 to the mesial side of the tooth 34, measuring approximately 0.5X0.6 cm in diameter.

15 18 mesio-angular 28 disto-angular horizontal impaction Condyle & sinus finding: no remarkable findings

16 Apical Radiographic finding There is an round-shaped, well defined radiolucency between 33 &34 over the alveolar septum. Not showing root resorption PDL space mild widening. The diameter of the lesion is The diameter of the lesion is approximately 5X6(mm)

17 Apical Radiographic finding Bone density decreased of alveolar ridge between een Discontinued of lamina dura

18 Differential diagnosis

19 Chief complaint: Swelling Inflammation & infection Neoplasm Inflammatory hyperplasia Retention phenomena Cysts

20 Inflammation & infection Color: normal Fever or local heat: (-) Pain: (-) No purulent drainage was present bleeding tendency:(-)

21 Inflammatory hyperplasia No prosthesis irritation Color: normal Fever or local l heat: (-) Pain: (-)

22 Retention phenomena Color: normal Fluctuation: (-) Consistency: hard

23 Chief complaint: Swelling Inflammation & infection Inflammatory hyperplasia Retention phenomena Cysts Neoplasm

24 Cysts

25 cyst Non-odontogenic odontogenic Odontogenic Developmental Nasolabial cyst Incisive canal cyst Globulomaxillary cyst Developmental l Radicular cyst Inflammatory

26 Odontogenic developmental cyst

27 Benign Neoplasm or Malignant tumor?

28 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 Benign 6. No facial nerve palsy 7. No bony invasion Features 8. well-defined radiolucency with corticated margin 1. Induration mucosamalignant 2. Fixed to overlying skin or 3. Ulceration of skin or mucosa 4. Rapid growth; growth spurt, Short duration 5. Pain, often severe 6. Facial nerve palsy (little numbness over lingual ) 7. Bony invasion 8. ill-defined radiolucency without corticated margin

29 Peripheral or intrabony origin? Adjacent mucosa seems normal appearance Induration:(-) Fluctuation:(-) Consistency: hard Mobility: fixed Peripheral Intrabony

30 Neoplasm Inflammation & infection Malginant Benign swelling Peripheral Intrabony Inflammatory hyperplasia Cysts Retention phenomena Non-odontogenic Odontogenic Developmental Developmental Inflammatory

31 1 Odontogenic developmental cyst 2 Benign intrabony tumor

32 Working diagnosis Odontogenic developmental cyst Lateral periodontal cyst Odontogenic keratocyst Benign intrabony tumor 1. Ameloblastoma (solid type) 2. Central giant cell granuloma 3. Neurilemmoma 4. Central Ossifying fibroma (Early stage)

33 1 Odontogenic developmental cyst

34 Lateral periodontal cyst

35 Lateral periodontal cyst Clinical feature Asymptomatic Less than 1cm in diameter No sexual predilection 20~90 y/o (the mean age is about 50 years)

36 Radiographic feature along the lateral root surface of a tooth Around 75~80% occur in the mandibular premolar-caninelateral incisor area Well-defined RL prominent cortical boundary Round or oval shape Rare large cyst have a more irregular shape

37 Radiographic feature affect the lamina dura of the adjacent root botryoid variety multilocular appearance (seldom appear) Large cyst can displace adjacent teeth and cause expansion

38 Lateral periodontal cyst

40 our case lateral periodontal cyst

41 Our case Lateral periodontal cyst gender male No sexual predilection age 35 y/o 20~90 y/o (mean age is 50 ) site Lower left buccal region. Mandibular premolar-canine- Lateral root surface of tooth. lateral incisor area. Lateral root surface of tooth. shape dome dome base sessile sessile swelling (+) (+)

42 Our case Lateral periodontal cyst size 1*0.8*0.4 cm 3 < 1cm in diameter consistency hard hard pain (-) (-) tenderness (-) (-) induration (-) (-) LAP (-) (-)

43 X-ray finding Our case Lateral periodontal cyst Border well-defined cortical boundary well-defined cortical boundary Radiodensity radiolucency radiolucency Effect on surrounding Bony hard swelling, but not Small cyst may effect the structures/adjacent affect teeth. lamina dura of the adjacent teeth Discontinued of lamina dura root Unilocular/ multilocular Unilocular Unilocular

44 Odontogenic keratocyst

45 Clinical feature From infancy to old ago about 60% found in 10 ~ 40 y/o A slight male predilection Small size usually asymptomatic Larger size associate with swelling over mucosa Pain may occur with secondary infection

46 Radiographic feature Well-defined d RL smooth and corticated margin in X ray Smooth round or oval shape or scalloped outline Most in posterior body of the mandible and ramus

47 Radiographic feature Some case has multilocular appearance (because of internal septa) Propensity to grow along the internal aspect of the jaw No obvious bone expansion

48 our case Odontogenic keratocyst

49 Our case Odontogenic keratocyst gender male A slight male predilection age 35 y/o from infancy to old ago about 60% found in 10 ~ 40 y/o site Lower left buccal region. Most in posterior body of the Lateral root surface of tooth. mandible and ramus shape dome dome base sessile sessile swelling (+) (+)

50 Our case Odontogenic keratocyst size 1*0.8*0.4 cm 3 consistency hard Hard (perforation firm fluctance) pain (-) (-) tenderness (-) (-) induration (-) (-) LAP (-) (-)

51 X-ray finding Our case Odontogenic keratocyst Border well-defined cortical boundary well-defined cortical boundary Radiodensity radiolucency radiolucency Effect on surrounding structures/adjacent teeth Bony hard swelling, but not affect teeth. Discontinued of lamina dura No obvious bone expansion. Occasionally expand and perforate the bone Unilocular/ multilocular lar Unilocular unilocular

52 2 Benign intrabony tumor

53 Ameloblastoma (Solid Type)

54 Clinical feature asymptomatic, large lesion may cause painless swelling of jaw. Locally invasive tumor, slow-growing. No gender predilection. in mandible, posterior region (molar-ramus region)

55 Clinical feature Buccal and lingual cortical expansion. Resorption of the roots of teeth. Teeth may be displaced and become mobile. Radiographic feature Usually well-defined and corticated border. Vary from unilocular RL to honeycomb or soap bubble y y p pattern ( bony septa creating internal compartment )

56 solid type solid or multicystic type Ameloblastoma multicystic type unicystic type

57 Ameloblastoma Solid or multicystic type (rare in younger,30~80 y/o) 86% 1.multicystic type: soap bubble honeycombed

58 Ameloblastoma Solid or multicystic type (rare in younger,30~80 y/o) 86% 2.solid type: It may appear as unilocular RL. When it grow large, it has scalloping margin around teeth. The border may be corticated or not corticated.

59 Ameloblastoma Unicystic type : (in young, 20~30 y/o)13% Often circumscribed RL around crown of unerupted mandibular third molar. Resorption of root is common.

60 Ameloblastoma solid type:

61 our case Ameloblastoma (solid type)

62 Our case Ameloblastoma (solid type) gender male No sexual predilection age 35 y/o rare in younger,30~80 y/o site Lower left buccal region. in mandible, posterior region shape Lateral root surface of tooth. dome base sessile sessile swelling (+) (+)

63 Our case Ameloblastoma (solid type) size 1*0.8*0.4 cm 3 Wide Range, often large and has scalloping margin around teethth consistency hard hard and bony pain (-) (-) tenderness (-) (-) induration (-) (-) LAP (-) (-)

64 X-ray finding Our case Ameloblastoma (solid) Border well-defined cortical boundary Not definitely Cortical boundary Radiodensity radiolucency radiolucency Effect on surrounding Bony hard swelling, but Buccal and lingual cortical structures/adjacent not affect teeth. expansion. teeth Discontinued of lamina dura. Unilocular/ multilocular Unilocular unilocular

65 Central giant cell granuloma

66 Clinical feature From 2-80 y/o (60% occur before age 30) 70% in mandible (Common in anterior jaws) Mandibular lesions frequently cross the midline Most are asymptomatic. Minor are with pain, paresthesia, ulceration

67 Radiographic feature RL Unilocular or multilocular Well delineated d non cortical margin From 5 mm to 10 cm in size no internal structure

68 Nonaggressive lesions: Most cases Few or no symptoms Slow growth No cortical perforation or root resorption Aggressive lesions: Pain, rapid growth, cortical perforation, root resorption Recur after treatment

69 our case Central giant cell granuloma

70 Our case Central giant cell granuloma gender male Non predilection age 35 y/o 60% before 30 y/o (from 2-80) site lower left buccal region mandibular anterior portion area Lateral root surface of tooth shape dome dome base sessile sessile swelling (+) (+)

71 Our case Central giant cell granuloma size 1*0.8*0.4 cm 3 From 5 mm to 10 cm consistency hard hard pain (-) Most (-) tenderness (-) (-) induration (-) (-) LAP (-) (-)

72 X-ray finding Our case Central giant cell granuloma Border well-defined cortical boundary well-defined no cortical boundary Radiodensity radiolucency radiolucency Effect on surrounding structures/adjacent teeth Bony hard swelling, but not affect teeth Discontinued of lamina dura. Bony hard swelling, seldom affect teeth Unilocular/ Unilocular Unilocular or multilocular multilocular

73 Neurilemmoma

74 Clinical features Benign neural neoplasm of Schwann cell origin. Slow growing, swelling, encapsulated. As it grow, it pushes the nerve aside. Asymptomatic, tenderness or pain may occur in some instance. Young and middle age adults Size can range from few millimeters to centimeters.

75 Tongue is most common location Arises centrally within bone and may produce bony expansion. Intraosseous are most common in posterior mandible. Pain and paresthesia are not usual for intrabony tumor. Commonly originated within inferior alveolar nerve.

76 Radiographic Features Well-defined unilocular or multilocular RL. Small lesions are cystic like

77 our case neurilemmoma

78 Our case Neurilemmoma (central type) gender male No sexual predilection age 35 y/o Young and middle age adults (20~30y/o) site lower left buccal region posterior mandible shape dome nodular base sessile sessile swelling (+) (+)

79 Our case Neurilemmoma (central type) size 1*0.8*0.4 cm 3 Size range from few mm to cm consistency hard hard pain (-) (-) tenderness (-) (-) induration (-) (-) LAP (-) (-)

80 X-ray finding Border Our case well-defined cortical boundary Neurilemmoma (central type) well-defined cortical boundary Radiodensity radiolucency radiolucency Effect on surrounding structures/adjacent teeth Bony hard swelling, but not affect teeth Cause root resorption Expansion of inferior alveolar canal Unilocular/ Unilocular Unilocular/multilocular multilocular

81 Central Ossifying fibroma (Early stage)

82 Clinical feature A wide age range, years old is most common Female predilection Mandibular premolar and molar area is the most common site > maxilla Small lesion seldom cause any symptoms Larger tumors result in a painless swelling of the involved bone Pain and paresthesia are rarely associated

83 Radiographic feature Well defined and unilocular Some show a sclerotic border vary degrees of RO with calcified material Root divergency Root resorption Large size will grow downward inferior cortex of the mandible

84 Central Ossifying fibroma Most of this pattern is RL with a few wispy trabeculae (arrow) A fibrous dysplasia granular-like pattern (arrow)

85 our case central ossifying fibroma

86 Our case Central ossifying fibroma gender male Female age 35 y/o y/o (A wide age range) site lower left buccal region Lateral root surface of tooth mandibular premolar and molar area shape dome dome base sessile sessile swelling (+) (+)

87 Our case Central ossifying fibroma size 1*0.8*0.4 cm 3 Small -large consistency hard hard pain (-) (-) tenderness (-) (-) induration (-) (-) LAP (-) (-)

88 X-ray finding Our case Central ossifying fibroma Border well-defined cortical boundary well-defined cortical boundary Radiodensity d it radiolucency radiolucency Effect on surrounding Bony hard swelling, but not Root divergence, Root structures/adjacent affect teeth. resorption teeth Discontinued of lamina dura. Unilocular/ multilocular Unilocular Unilocular

89 Clinical Impression Odontogenic developmental cyst Lateral periodontal cyst Benign intrabony tumor Ameloblastoma (solid type)

Microsoft PowerPoint - 口診seminar第四組.pptx

Microsoft PowerPoint - 口診seminar第四組.pptx 口腔診斷學 SEMINAR 第 4 組指導老師 : 王文岑醫師陳玉昆醫師組員名單組長 : 吳健恒組員 : 吳承光陳威齊陳覺斌陳梅信吳詠霞葉彥宏林曉怡高秉宏洪裕盛 HISTORY AND EXAMINATION GENERAL DATA Name: OOO Chart no.: Case 4 Sex: Female Age: 60 y/o Marital status: Marriage