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1、WenChen WangDifferential Diagnosis of Oral and Maxillofacial lesions 王文岑 高雄醫學大學 牙醫學系高醫大附設醫院S 棟 2 樓 口腔病理影像診斷科 07-3208284; wcwangkmu.edu.twGeneral principles of Differential Diagnosis 1. History and examination of the patient 2. The diagnosis sequence鑑別診斷的基本原則- 問診與檢查 診斷的步驟WenChen Wang學習目標|瞭解主訴的涵義|瞭解問診
2、的內容|熟悉診斷的步驟|瞭解各種檢查方法之使用時機學習資源及主要圖片引用: 1. Differential diagnosis of oral lesion. Wood, Gooz(Mosby), 5th ed., 1997. 2. 口腔病理科門診臨床記錄WenChen WangClinical pathology, a study of changePurpose: overview of significance and application of medicine in the dentistry The dentist does not only treat “teeth in pa
3、tients “ but patients who have teeth or not”. WenChen WangHistory Clinical exam (radiographs if needed Definitive Dx.Working Dx.Biopsy and/or Lab testsTx by experienceDefinitive Dx.Response to specific RxResolution with no diagnosisNo resolutionBiopsy and/or Lab testsDefinitive Dx.Possible Possible
4、Procedures Procedures Leading to Leading to DiagnosisDiagnosisClinical pathologyWenChen WangIN the procedures, you have to do1. To identifiedundetected systemic disease 2. To identified taking drug or medicine as clue 3. To modify treatment planning 4. To protect medical-dental legal standpoint 5. T
5、o communicate medical consultants 6. To establish good patient-dentist relation shipWenChen WangThe Diagnostic Sequence 1. Detection and examination of the lesion 2. Examination of the patientChief complaintsOnset and course 3. Re-examination of the lesion 4. Classification of the lesion 5. Listing
6、the possible diagnosis 6. Developing the differential diagnosis 7. Working diagnosis 8. Final diagnosis WenChen Wang1. RECORDING THE IDENTIFYING DATA 2. HISTORY AND PHYSICAL EXAMINATION 3. CHIEF COMPLAINT 4. PRESENT ILLNESS 5. PAST MEDICAL HISTORY Family historySocial historyOccupational history Den
7、tal history 6. REVIEW OF SYMPTOMS BY SYSTEM 7. PHYSICAL EXAMINATION Radiologic examination 8. DIFFERENTIAL DIAGNOSIS 9. WORKING DIAGNOSIS 10. Medical laboratory studies 11. Dental laboratory studies 12. Biopsy Incisional Excisional Fine-needle aspiration Exfoliationg cytologyToludine blue staining 1
8、3. Consultation 14. FINAL DIAGNOSIS 15.TREATMENT PLANWenChen Wang1.Detection and examination of the patients lesion|History taking |Inspection|Palpation|Percussion|Aspiration, |Auscultation|Radiographic examination|Laboratory examinationWenChen WangHistory Taking|What, where, when, howChief complain
9、tPresent illness|Past medical historyFamily historySocial historyOccupational historyDental history|Review of symptoms by system|Physical examinationRadiographic examinationWenChen WangChief complaint(s)|Pain|Soreness|Burning sensation|Bleeding |Loose teeth|Recent occlusal problem|Delayed tooth erup
10、tion|Dry mouth |Too much saliva|Swelling |Bad taste|Halitosis|Parthesia and anesthesiaWenChen WangPain- Location，sharp or dull, severity, duration, precipitating circumstances|Teeth|Mucous membrane|Salivary gland inflammation or infection|Lesions of the jaw bone |LN inflammation and /or inflammation
11、|TMD, MPD|Sinus diseases|Ear diseases|Psychoses|Angina pectoris, neuralgia WenChen WangSoreness -presence of mucosa inflammation or ulcers Burning sensation -thinning or erosion of the surface epi. |Burning mouth syndrome Xerostomic condition Anemia Vitamin deficiencies| Psychosis| Neurosis| Viral,
12、fungal or chronic bacterial infectionWenChen Wang口腔灼熱症 (Burning mouth syndrome)|Gender effects : F:M = 3:1 7:1|Age: Middle-aged and elderly-agedLocal and systemic preciptating factors:|Hematinic deficiency state|Undiagnosed maturity onset diabetes|Oral candidal infection|Xerostomia|Denture design fa
13、ults|Parafunction habits|Cancerphobia|Allergy|Psychological state|Drug induced|Hypothyroid function|常伴有腸躁症、恐癌症 (cancerphobia) 、看遍各科及名醫WenChen WangAfter tx. Vit. B12 defficiency (Pernicious anemia)|口腔黏膜灼熱感、疼痛From: Oral pathology dept KMUHWenChen WangBleeding|Gingivitis and periodontal disease|Traumat
14、ic incidence, surgery|Inflammation |Tumors (traumatized tumor or vascular tumors)|Diseases associated with deficiencies in hemostasis WenChen WangBleedingPeriodontitisHematomaErythema multiformleukemiaFrom: Oral pathology dept KMUHWenChen WangLoose teeth-Loss of supporting bone or resorption of root
15、s|Perio. Problem|Trauma|Pulpoperiapical lesions|Normal resorption of primary teeth|Benign tumors-root resorption |Malignant tumors-supporting bone destruction WenChen WangRecent occlusal problem-recently teeth dont bite right or recently teeth are out of line|Overcontoured restorations |Periodontal
16、disease, periapical abscess|Traumatic injury, tooth fracture|Tumor or cyst of tooth-bearing regions of the jaws|Fibrous dysplasia WenChen WangDelayed tooth eruption|Malposed eruption or impacted teeth|Cyst |Odontomas, mesiodens|Sclerotic bone|Tumors|Maldevelopment|Generalized delayanodontia, cleidocranial dysplasia or hypothyroidism WenChen WangDelayed tooth eruptionFrom: Oral pathology dept KMUHWenChen WangCleidocranial DysplasiaFrom: Oral pathology
