Microsoft PowerPoint - 口診seminar第四組.pptx

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1 口腔診斷學 SEMINAR 第 4 組指導老師 : 王文岑醫師陳玉昆醫師

2 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

3 HISTORY AND EXAMINATION

4 GENERAL DATA Name: OOO Chart no.: Case 4 Sex: Female Age: 60 y/o Marital status: Marriage Occupation: Housewife

5 CHIEF COMPLAINT A lesion over lower left jaw and pain over upper left posterior teeth.

6 PRESENT ILLNESS This 60 y/o female suffered from sharp pain over teeth 27 long time ago and she also felt pain when touching lower left teeth. She went to a LDC for treatment last week. After radiographic exam, the dentist found a lesion over lower left mandible. Then she was referred to our OPD for further evaluation and treatment.

7 EXTRAORAL EXAMINATION Profile: convex Facial asymmetry y Lymphadenopathy: (-)

9 INTRAORAL EXAMINATION Pain,hard swelling over lower anterior Base: sessile Shape: dome Color: red Mobility: fixed Fluctuation: (-) Tenderness: (-) Induration: (-) Lymphadenopathy: (-)

10 INTRAORAL EXAMINATION Improper long span crown &bridge at maxilla:16~27 C&B and cantilever:33~36 C&B C&B:42,43,44 Missing:12,13,16,17,18,12,25,26,28,35,36,37,38,45,46, 47,48 Post&core:11,21 Sharp pain,gingival swelling at tooth 27 Percussion pain at tooth 27,33,34,42,43, 44 Plaque and calculus deposition

11 PAST MEDICAL HISTORY Systemic disease history: Thyromegaly (cured) Allergic reaction: Unknown drug( 感冒藥 ) Hospitalized history: Thyroidectomy Current medicine: Denied

12 PAST DENTAL HISTORY Post and core Prosthesis fabrication --crown and bridge --cantilever

13 PERSONAL HABIT Risk factors related to malignancy: Alcohol l drinking: (-) Betel-quid chewing: (-) Cigarette smoking: (-) Oh Others: Denied other specific oral habits

14 RADIOGRAPH - PANO

15 There is a Ill-defined multilocular irregular shaped radiolucency with non-corticated margin extending from mesial aspect of tooth 43 to left mandible body, measuring approximately 3 x 9 cm in diameter, cortical destruction of lower border can also be found.

16 Left maxillary sinus: enlargement Secondary caries: tooth 27 Internal resorption: tooth 22 Tooth attrition: tooth 31,32,41 Periapical pathology: tooth 43

17 DIAGNOSIS CLASSIFICATION OF LESION POSSIBLE DIAGNOSIS DIFFERENTIAL DIAGNOSIS CLINICAL IMPRESSION

18 CLASSIFICATION OF LESION

19 GENERAL CLASSIFICATION A Lesion Inflammation Cyst Neoplasm

20 Inflammation In our case: Color: red Fever or local heat (-) Pain (+) Swelling(+) => bony hard swelling Purulent drainage (-) Caries (-) Cyst Neoplasm

21 A Lesion Inflammation Cyst Neoplasm

22 Cyst In our case: Color: red Fever or local l heat (-) Pain (+) Swelling(+) => bony hard swelling Purulent drainage (-) Caries (-) Cyst Neoplasm

23 Cyst Nonodontogenic Odontogenic Developmental Inflammatory

24 NEOPLASM BENIGN OR MALIGANT? Neoplasm Benign Malignant

25 Neoplasm Pain (+) Tenderness (-) Lymphadenopathy (-) Ulceration (-) Induration (-) Numbness (-) Smooth surface Slow growth Well-defined radiolucency Benign

26 Neoplasm Benign Malignant Or Benign aggressive

27 NEOPLASM CENTRAL OR PERIPHERAL? Neoplasm

28 Neoplasm Induration (-) Consistency: hard Bone destruction (+)

29 Neoplasm

30 Classification of lesion Odontogenic Cyst or Central Type Malingnant(or beging g aggressive) Tumor

31 Possible diagnosis Cyst Neoplasm 1. Glandular odontogenic cyst 1. Ameloblastic eobastccarcinomac a 2. Odontogenic myxoma Others 1. Central giant cell lesion 2. Hemagioma 3. Malignant neurolemmoma

32 DEFERENTIAL DIAGNOSIS S

33 1. AMELOBLASTIC CARCINOMA

34 AMELOBLASTIC CARCINOMA (CLINICAL) Our case Ameloblastic carcinoma Gender Female No sexual predilection Age 60 4~75 y/o (mean age,30years) Symptom Pain occurs when touching lower left teeth Asymptomatic, a painless swelling or expansion of the jaw Site Left mandibular body to the symphysis y (cross the midline) Color Red Red Shape Dome Dome sessile 85% mandible, most often in the molar-ascending ramus area 15% maxilla

35 AMELOBLASTIC CARCINOMA(CLINICAL) (CONT.) Our Case Ameloblastic Carcinoma Tenderness - Painless Pain + + LAP - Cervical lymph nodes Consistency Hard Hard Frequency Unknown In Blacks or no predilection

36 AMELOBLASTIC CARCINOMA(X RAY FINDING) Our case Ameloblastic Carcinoma Border Ill-defined margins Ill-defined margins Radiodensity Radiolucency Radiolucency Effect on surrounding structures/adjacent teeth Bony hard swelling, Teeth pain when touching Metastases to lungs and cervical lymph nodes are the most common. Solid, bony hard swelling, cortical destruction Unilocular/multilocular Multilocular Multilocular

37 2. ODONTOGENIC MYXOMA

38 ODONTOGENIC MYXOMA Our case Odontogenic myxoma Gender Female No sexual predilection Age Unknown Occur over a wide age group Symtom Site Pain occurs when touching lower left teeth Left mandibular body to the symphysis y (cross the midline) (average age,25~30years) Smaller:aymptomatic and are discovered only during a radiographic examination. Larger:often associated with a painless expansion of the involved bone 見下圖 Shape Dome Dome size 30*90cm 3.0*9.0 No usual size

40 AMELOBLASTIC CARCINOMA(CONT.) Tenderness - Painless LAP - - Border Ill-defined d margins Ill-defined d irregular or scalloped margins Radiodensity Radiolucency Radiolucency Effect on surrounding Bony hard swelling, May displace or cause structures/adjacent Teeth pain when resorption of teeth in the teeth touching area of the tumor. Unilocular/multilocular Multilocular Unilocular or multilocular(soap bubble)

41 3. GLANDULAR ODONTOGENIC CYST

42 GLANDULAR ODONTOGENIC CYST Our Case Glandular Odontogenic Cyst Age 60 y/o Middle-aged adult,mean age 49, rarely occure on age <20 Site Left mandibular body to the symphysis (cross the midline) Mandible, anterior region, always cross midline Swelling (+) Clinical expansion Size 3.0 x 9.0 cm Samll to large Pain (+) Sometimes Symptom Swelling, pain when touching Small lesion: asymptom on mandible Large lesion: swelling, pain or paresthesia

43 GLANDULAR ODONTOGENIC CYST (X-RAY) Our Case Glandular Odontogenic Cyst Border Ill defined with noncorticated Radiodensity Radiolucency Radiolucency Well defined with a sclerotic rim Unilocular/multilocular Multilocular Multilocular

44 4. CENTRAL GIANT CELL LESION

45 CENTRAL GIANT CELL LESION Our Case Gender F F>M Central Giant Cell Lesion Age (60%< 30yrs) Site Left mandibular body to the symphysis (cross the midline) Color Red Predominant red Mandible frequently cross midline Pain (+) Mostly asymptomatic, minority: pain, paresthesia Size 3.0 x 9.0cm Small: 5x5mm to Large: 10cm Swelling (+) (+) Base Sessile Sessile Shape Dome Dome (similar to pyogenic granuloma) Surface Smooth Smooth

46 CENTRAL GIANT CELL LESION (X-RAY) Our Case Central giant cell lesion Border Ill-defined Well-defined Radio density Soap bubble Soap bubble Unilocular / multilocular Multilocular Multilocular or unilocular

47 5. HEMANGIOMA

48 HEMANGIOMA- INTRABONY VASCULAR MALFORMATIONS Our case Gender Female Female hemangioma Age 60 Most between 10 and 20 years of age Frequency Symtom Pain occurs when touching Asymptomatic lower left teeth Some with pain or swelling Mobility of teeth or bleeding from gingival sulcus A Bruit or pulsation may be apparent on auscultation and palpation Site Size Left mandibular body to the symphysis (cross the midline) 3.0*9.0 cm Mandible : maxilla=2:1

49 AMELOBLASTOMA(CONT.) Tenderness - Our Case Ameloblastoma X-ray finding Multilocular radiolucent Most Multilocular radiolucent Honeycomb or soap bubble appearance Border Ill-defined margins Well or ill-defined margins Radiodensity Radiolucency cy Radiolucency cy Effect on surrounding structures/adjacent teeth Bony hard swelling, Teeth pain when touching Large-cortical expansion Unilocular/multilocular Multilocular multilocular

50 6. CENTRAL NEUROLEMMOMA

51 CENTRAL NEUROFIBROMA Our case Malignant neurolemmoma Age 60 Young and middle age Symtom Site Pain occurs when touching lower left teeth Left mandibular body to the symphysis (cross the midline) May produce bony expansion, Pain or paresthesia are not unusal When within bone, most common in the posterior mandible Radiograph Ill-defined multilocular Unilocular or multilocular

53 CLINICAL IMPRESSION 1. Odontogenic myxoma 2. Central giant cell granuloma

54 THANK YOU FOR YOUR ATTENTION

55 補充資料 AMELOBLASTOMA ODONTOGENIC CYST RADICULAR CYST CHRONIC OSTEOMYEOLITIS

56 1.AMELOBLASTOMA

57 AMELOBLASTOMA Our case Ameloblastoma Gender Female No sexual predilection Age 60 20~70 y/o Rare younger than 20y/o Frequency In Blacks or no predilection Symtom Pain occurs when touching lower left teeth Asymptomatic, a painless swelling or expansion of the jaw Site Left mandibular body to the symphysis (cross the midline) 85% mandible, most often in the molar-ascending ramus area 15% maxilla Size 3.0*9.0 cm No usual size

58 AMELOBLASTOMA(CONT.) Our Case Ameloblastoma X-ray finding Multilocular radiolucent Multilocular radiolucent Border Ill-defined margins Well-defined margins Radiodensity Radiolucency Radiolucency Effect on surrounding structures/adjacent teeth Bony hard swelling, Teeth pain when touching Unilocular/multilocular Multilocular Multilocular Buccal and lingual cortical expansion Is frequently. Resorption of roots of teeth adjacent to the tumor

59 2. ODONTOGENIC KERATOCYST

60 ODONTOGENIC KERATOCYST Our Case Odontogenic Keratocyst Gender Female Male predilection (slightly) Age 60 y/o From infancy to older y/o, about 60% Site Left mandibular body to the Most in posterior body of the symphysis (cross the mandible and ramus midline) Shape Dome Dome Base Sessile Sessile Swelling + + (Tooth 27 and lower left gingival swelling)

61 ODONTOGENIC KERATOCYST Consistency Hard Hard Pain + + (large in size) - (small in size) Tenderness - - Induration - - Lymphadenopathy(LAP) - -

62 ODONTOGENIC KERATOCYST X-ray findings Our Case Odontogenic Keratocyst Border Ill-defined with no corticated margin Well-defined corticated boundary Radiodensity Radiolucency Radiolucency Effect on surrounding structure/ adjacent tooth No obvious bone expansion Facial asymmetry No obvious bone expansion Jaw asymmetry Unilocular/multilocular Multilocular Unilocular/multilocular

63 3.RADICULAR CYST

64 Radicular Cyst Our Case Radicular Cyst Pain + No symptoms unless it becomes infected, the tooth and swelling develop all the painful symptoms of an abscess Swelling + Small(>1.6cm would be suggestive) to large(complete l quandrant) Radiographic size 3.0 x 9.0 cm Cannot be used for the definitive diagnosis Site Cross midline Complete quadrant Shape Dome Dome Consistency Hard It is bony hard to palpation, but later it may demonstrate a crackling sound as the cortical plate becomes thinned

65 4.CHRONIC OSTEOMYLITIS

66 CHRONIC OSTEOMYLITIS Our case Chronic osteomylitis Gender Female Male(75%) Age 60 All age (uncommon for under 30) Symptom Site Pain occurs when touching lower left teeth Left mandibular body to the symphysis (cross the midline) Swelling, pain mandible

67 CHRONIC OSTEOMYLITIS (X-RAY) X-ray finding Our case Chronic Osteomylitis Border Ill-defined margins Patchy, ragged, illdefined contains central radiopaque sequestra Radiodensity Radiolucency Radiolucency Effect on surrounding structures/adjacent teeth Bony hard swelling, Teeth pain when touching

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