口腔诊断学

口腔診斷學口腔診斷學SeminarSeminar指導醫師：王文岑醫師指導醫師：王文岑醫師報告日期：報告日期：96.11.1696.11.16報告人：牙五報告人：牙五第二組第二組張修源張修源李家榮李家榮賴勇雙賴勇雙余彥頡余彥頡徐重興徐重興林煒倫林煒倫黃文信黃文信林蔚庭林蔚庭趙珮容趙珮容楊冠恆楊冠恆Part1Part1––BasicInformationBasicInformationGeneralDataGeneralData•Name:XXX•Gender:Female•Age:26y/o(93年)•Native:高雄市•Maritalstatus:Married•Occupation:教•Firstvisit:93/XX/XXChiefComplaintChiefComplaint•Amassoverbuccalgingivaofleftmaxillarypremolar(1st&2nd)areafor1~2months.PresentIllnessPresentIllness•This26y/ofemalepatientnotedthatshehadamassoverbuccalgingivaoftooth24&25inthebeginningoftheMarchthisyear.Andat3.13shedidthebiopsyexamination.Afteraperiodoftime,shefoundamassatthesamesite,soshewenttoOSOPDforexcisionalbiopsyat4.17.AndthespecimenwassentforH-Pexamination.PastHistoryPastHistory•Pastmedicalhistory--Nettlerash(+)--Hospitalization(-)--Deniedanysystemicdisease--Deniedanydrugallergy--Pregnancyfor30weeks•Pastdentalhistory--norecord.FamilyHistoryandAllergyHistoryFamilyHistoryandAllergyHistory•Familyhistory:notcontributory•Foodallergyhistory:pineapplePersonalHistoryPersonalHistory--OralHabitsOralHabits•RiskfactorrelatedtoMalignancy--Alcohol(-)--Betelnut(-)--Cigarette(-)•Noanyspecialhabits.Part2Part2––ClinicalExaminationClinicalExaminationIntraoralIntraoralExaminationExamination•Adome-shapedswellingmasswithulcerativesurface,measured1.6×1.2cmindiameterlocatedover24and25buccalgingivalarea.•Pedunculatedbase,redsurfacecolorwithfirmconsistency.•Themassiseasilybleeding.•Calculusandplaquedeposition.(poororalhygiene)OralandMaxillofacialExaminationOralandMaxillofacialExamination•Dome-shapedswelling•Reddishcolor•Ulcerated(+)•Fixed(+)•Firm(+)•Tenderness(+)•Bleedingtendency(++)•Fluctuation(-)•Induration(-)•Pulsation(+)•Pain(?)•Lymphadenopathy(?)•Calculusandplaquedeposition•Crowding:26,27.•Supra-eruption:27.•NootherabnormalitieswereobservedRadiographicExaminationRadiographicExamination((periapicalperiapicalfilm)film)Part3Part3––DifferentialDiagnosisDifferentialDiagnosisDifferentialDiagnosisDifferentialDiagnosis•Inflammation?Cyst?Neoplasm?--Fluctuation(-)--Firm(+)RuleoutcystDifferentialDiagnosisDifferentialDiagnosis•Central?orPeripheral?(1).Pedunculated(+)(2).Boneexpansion(-)(3).Rootresorption(-)(4).mucosalesion(+)PeripheralDifferentialDiagnosisDifferentialDiagnosis•Inflammation?orNeoplasm?Reddishswelling(+)Bleedingtendency(++)Tenderness(+)Ulcerated(+)IfFeverorlocalheat(+)IfFeverorlocalheat(-)Poororalhygiene(+)Lymphadenopathy(?)rapidrecurrent(+)DifferentialDiagnosisDifferentialDiagnosis•IfNeoplasmÆBenign?ormalignant?Induration(-)Ulceration(+)Irregularboneresorption(-)Rapidgrowth(+)Welldefinedmargine(+)smoothsurface(+)Benign??DifferentialDiagnosisDifferentialDiagnosis•IfInflammationÆ1.PyogenicGranuloma(Pregnancytumor)2.Ulcerativeperipheralgiantcellgranuloma3.Peripheralossifyingfibroma4.EpulisgranulomatosumRuleoutEpulisgranulomatosumÆextrationsocketSite:anygingivalareaDifferentialDiagnosisDifferentialDiagnosis•IfBenigntumorÆ1.Exophyticcapillaryhamangioma2.PeripheralodontogenictumorPart4Part4––WorkingDiagnosisWorkingDiagnosisWorkingDiagnosisWorkingDiagnosisFromhighercompatibletolesscompatible:•Pyogenicgranuloma(Pregnancytumor)•Peripheralossifyingfibroma•Ulcerativeperipheralgiantcellgranuloma•Exophyticcapillaryhamangioma•Peripheralodontogenictumor•EpulisgranulomatosumPyogenicPyogenicgranulomagranulomaHighercompatibleClinical---•Color：pinktoredtopurple•Bleedingeasily，ulceration•Mobility：fixed•Shape：lobulated、Pedunculated•目視有搏動感(pulsation)：fullofcapillaries•Site：freegingiva、interdentalpapilla(maxillarymandibular；ant.post.)→Pyogenictumor，Granlomatousstage•RapidgrowthPyogenicPyogenicgranulomagranulomaClinical---•Youngpyogenicgranulomaarehighlyvascularinappearance,olderonebecomemorecollagenizedandpink•Painless•Gingivalirritationandinflammationduetopoororalhygienemaybeaprecipitatingfactor•任何年齡都可能,好發於小孩子和年輕人,可能因為hormone的關係女性較容易有,尤其在懷孕女性的前三個月(Increasinglevelsofestrogenandprogesterone)Radiographic---Nospecialfinding(notinvolvedhardtissue)Reddish(younglesion)Pink(olderlesion)PeripheralossifyingPeripheralossifyingfibromafibroma•Highercompatible：Clinical---¾Red,ulceratedlesion(earlystage)¾Site--gingiva,usuallyemanatefrominterdentalgingiva(maxillarymandibular；ant.post.)PS：50%occurinincisor-cuspidregion¾Childlessandyoungadults,femalepredilectionPeripheralossifyingPeripheralossifyingfibromafibroma•Lesscompatible：Clinical---¾nodularmass¾pink,non-ulceratedlesion(olderstage)numerousfibroblasts,sparsecollagenandbasophilicmineralizedmaterial.UlcerativeperipheralgiantUlcerativeperipheralgiantcellcellgranulomagranuloma•Highercompatible：Clinical---¾Colormaybebluishorredtopalepink¾Polypoidornodular¾Ulcerativesurface¾Posteriorgingivaoredentulousalveolarridge¾Rapidgrowth¾FemalemaleUlcerativeperipheralgiantUlcerativeperipheralgiantcellcellgranulomagranuloma•Lesscompatible：Clinical---¾Rubbertosoftonpalpation¾30to70age¾MandibularmaxillaryUlcerativeperipheralgiantUlcerativeperipheralgiantcellcellgranulomagranulomaUlcerativeperipheralgiantUlcerativeperipheralgiantcellcellgranulomagranulomaUlcerativeperiphera