口腔病理診斷科 Clinicopathological conference Intern Case Report

1. 口腔病理診斷科Clinicopathological conferenceIntern Case Report 指導老師: 林立民醫師 陳玉昆醫師 王文岑醫師 陳靜怡醫師 D組：楊駿恒‧鄭婉伶‧曾偉哲‧蔡馥慧‧李佩昕 95,02,07

3. General data • Name : 金XX • Gender : female • Age : 13 • Native : 高雄市 • Occupation : 學生 • First visit : 94/09/24 • Attending V.S. :黃逸岳醫師

4. Chief Complaint Unerupted lower left second molar

5. Present Illness • The 13 y/o female p’t suffered from 37 unerupted tooth. She went to see Dr.謝尚廷 10 months ago. The dentist found there was a dentigerous cyst and referred her to Dr.柯政全 for help. • Dr.柯referred her to our OPD for examination and treatment.

6. Past History • Past medical history • Denied any systemic disease • Denied any drug or food allergy • Hospitalization : • Nil • Past dental history • Attitude：afraid • Extraction • O.D

7. Personal History Alcohol : (-) Betel nut : (-) Cigarette : (-)

8. Intraoral Examination • 37 unerupted tooth • Mild swelling on 37 area • Mild expansion • No purulent drainage was presented • Overlying mucosa: normal color • No loosening teeth

9. Panorex(940924) 18, 28, 38, 48, 37 uneruption A well-definedovoid-shaped radiolucent lesion with regular corticated margin over 37 coronal part to the root trunk, measuring 3x2.5 cm. The superior border of mandible body over 37 area seems absent. The left mandibular canal is narrowed and indented over 37 apical area. 37 is well-developed and submerged down to the level 1 cm below the superior alveolar ridge.

10. Lateral view

11. PA view

12. Water’s view

13. Inflammation or Neoplasm? • Intrabony cystic lesion? Benign or Malignant?

14. Inflammation or Neoplasm? • No purulent drainage was presented • No fever • No complaint of pain or other uncomfortable symptom • Overlying mucosa: normal color Neoplasm

15. Benign or Malignant? • A well-defined R-L bony lesion with regular, corticated border. Benign 可能為一個 Intrabony benign tumor

16. Intrabony cystic lesion? • Overlying mucosa: normal color • A well-defined R-L lesion with corticated border 可能為一個 Intrabony cystic lesion

17. WorkingDiagnoses Intrabony benign tumor • Unicystic ameloblastoma • Ameloblastoma • Ameloblastic fibroma • Odontogenic fibroma • Odontogenic myxoma • Adenomatoid odontogenic tumor (AOT) Intrabony cystic lesion • Dentigerous cyst • Odontogenic keratocyst

18. Unicystic ameloblastoma

19. Ameloblastoma

20. Ameloblastic fibroma

21. Odontogenic fibroma

22. Odontogenic myxoma

23. Adenomatoid odontogenic tumor(AOT)

24. Dentigerous cyst

25. Clinical Impression • Dentigerous cyst, 37 area • Unicystic ameloblastoma, left mandibular body over 37 area

26. Treatment Course • Incisional Biopsy on 940924

36. HP report： Odontogenic myxoma with features of cystic odontoma over 37 area

37. Treatment Course cont~ • OP on 94/10/21 • (Hospitalization:10/20~10/25) • Extraction of 36 37 38 48 • Excision + bone trimming • Bone graft (Bio-oss x 3 BT) • Primary closure

38. Treatment Course cont~ 94/10/22

39. Treatment Course cont~

40. Treatment Course cont~

41. Treatment Course cont~

42. Treatment Course cont~

43. Treatment Course cont~

44. Treatment Course cont~ HP report— • Odontogenic myxoma 37 area • Root resorption 36 37

45. Treatment Course cont~ OPD follow up— • 941029 No numbness and paresthesia Wound dehiscence • 941105 Re-suture

46. Treatment Course cont~ 94/11/19

47. Discussion

48. odontogenic myxomaDefinition • World Health Organization’s classification for histological typing of odontogenic tumors: “A benign tumor, which is of ectomesenchymal origin and is a locally invasive neoplasm consisting of rounded and angular cells lying in an abundant mucoid stroma”

49. odontogenic myxomaRelative Prevalence • The relative prevalence of odontogenic myxoma is 0.2–17.7% of all odontogenic tumors.

50. DISCUSSION radiology clinical pathology