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1、口腔診斷學ppt课件Stillwatersrundeep.流静水深流静水深,人静心深人静心深Wherethereislife,thereishope。有生命必有希望。有生命必有希望學 習 目 標1. 明白頸部腫脹之鑑別診斷明白頸部腫脹之鑑別診斷1.Wood, Goaz. Differential Diagnosis of Oral Lesions. Mosby Publisher, 3rd Edition, Chapter 29, 634-5.2.自購網路資源：自購網路資源：super_toolcool 3.網路資源網路資源 (anonymous)4.口腔影像的臨床診斷口腔影像的臨床診斷, 2
2、nd edition, Chapter 12, p.2835.Eric Whaites: Essentials of dental radiography & radiology 3rd edition, Chapter 31, p. 403-4146.Kaohsiung Medical University Oral Pathology7.Crispian Scully. Handbook of oral disease - diagnosis and management. Martin Dunitz Publisher, 1st ed. p. 267-8, 3768.Yeshwant B
3、. Rawal, Carl M. Allen, John R. Kalmar. A nodular submental mass. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:734-79.彼得彼得 史彼爾人史彼爾人. 漢聲雜誌漢聲雜誌 民國民國86, 5月月, p. 810.Carlson ER et al. Neck dissections for oral/head and neck cancer:1906-2006. J Oral Maxillofac Surg 2006;64:4-1111. Misra S et
4、 al. Management of gingivobuccal complex cancer. Ann R Coll Surg Engl 2008;90:546-5312.WoolgarJ et al. Neck dissections: A practical guide for the reporting histopathologist. Current Diag Pathol 2007;13:499-511References:參考資料Contains many vitalanatomic structures& diverse tissue typesDiverse and var
5、iedpathological lesionsExamination of neckshould be performedin patient evaluationConstitutes a small %of the total body areaRefs. 2, 3, 9 Certain lesions are found in discrete anatomic locations A knowledge of those lesions associated with specific regions in the neck is useful Mass of nonspecific
6、location Skin & subcutaneous tissues within the neck - mobile skin - cervical fasciaRegional approachRef. 2Mass of specific location Masses in submandibular region Masses in parotid region Masses in median-paramedian region Masses in lateral regionsubmandibleparotid(para)medianlateral Which region w
7、ill have which lesions Ref. 11. Submental node 2. Submandibular node3. Cranial jugular (deep cervical) node4. Medial jugular (deep cervical) node5. Caudal jugular (deep cervical) node6. Dorsal jugular (superficial cervical) node along accessory n7. Supraclavicular node8. Prelaryngeal & paratracheal
8、node9. Retropharyngeal node10. Parotid node11. Buccal node12. Retroauricular & occipital node12 cervical lymph nodesRef. 1Levels 1-III:Sentinel LN oforal cancer(1st meta LNs) Refs. 10, 11Levels I-V: Basis ofthe nomenclature for the classification of neck dissections for oral/head & neck cancersRef.
9、10Ref. 12Ref. 12Ref. 12Ref. 12Ref. 12Ref. 12Mass of specific location Masses in submandibular region Lymph nodes: first echelon node - the first node that encounter the tumor cell or microorganism Lymph nodes: enlargement - Infection: lymphoid hyperplasia : acute lymphadenitis - metastatic cervical
10、node - lymphoma Ref. 1Mass of specific location (觸診觸診) Masses in submandibular region Lymph nodes: enlargement - Infection: lymphoid hyperplasia movable, painless, non-tender : acute lymphadenitis movable/fixed, painful, tender - metastatic cervical node fixed, painless, non-tender, hard - lymphoma
11、(solitary/multiple; uni/bilateral) fixed, painless, non-tender, rubber/firmRef. 1 Find the origin: - Infection: lymphoid hyperplasia : acute lymphadenitisInfection source- pericoronitis (third molar) - infected cyst - metastatic cervical nodePrimary tumor oral SCC, NPC, others - lymphoma (solitary/m
12、ultiple; uni/bilateral)History, biopsy, imaging examination Ref. 2Mass of specific location Masses in submandibular region Submandibular space infection (cellulitis) Pericoronitis (third molar), infected cyst Submandibular gland infection (sialadenitis) Pain & swelling prior to eating Submandibular
13、gland neoplasm Biopsy, imaging examination (sialography, CT)Ref. 1Mass of specific location (觸診觸診) Masses in parotid region Enlarged lymph nodes - Infection: lymphoid hyperplasia movable, painless, non-tender : acute lymphadenitis movable/fixed, painful, tender - metastatic cervical node fixed, pain
14、less, non-tender, hard - lymphoma (solitary/multiple; uni/bilateral) fixed, painless, non-tender, rubber/firmRef. 1 Locate the origin: - Infection: lymphoid hyperplasia : acute lymphadenitisInfection source- infected cyst (congenital preauricular cyst, sebaceous cyst) - metastatic parotid nodePrimar
15、y tumor oral SCC, NPC, others - lymphoma (solitary/multiple; uni/bilateral)Biopsy, imaging examination Ref. 2Mass of specific location Masses in parotid region Parotid gland infection (parotitis) Stone in Stensens duct, virus, bacteria Parotid gland neoplasm Benign (70%), malignant (30%) Biopsy, ima
16、ging examination (sialography, CT)Ball in handRefs. 2, 4, 5Mass of specific location Masses in parotid region Bilateral parotid enlargement Mikuliczs disease Benign lymphoepithelial lesion (enlargement of parotid, lacrymal glands) Mickuliczs syndrome (非非lymphoepithelial lesion) Associated with lymph
17、oma, sarcoidosis, TB Sjogrens syndrome Xerostomia, conjunctivitis, rheumatoid arthritisBiparotid enlargementXerostomiaDry eyePrimary Sjogren syndromeSecondary Sjogren syndromeXerostomiaConjunctivitissiccaConnective tissuedisease (auto-immune disease)Ref. 7General Datau姓名：杜姓名：杜XXu性別：男性別：男u年齡：年齡：34歲歲u
18、出生地：苗栗出生地：苗栗u居住地：高雄居住地：高雄u婚姻狀況：已婚婚姻狀況：已婚u初診日期：初診日期：X年年X月月X日日Ref. 6Chief Complaintu A swelling mass of Rt parotid areaRef. 6Present IllnessuThis 34 y/o male has found a nodule over right infra-auricular area for 56 years, which was painless and no special feeling. So, he didnt pay attention about it.
19、 Recently he went to LDC for full mouth scaling, the LDC dentist noted this swelling. According to his statement, he felt it grew larger and tenderness recently. So, he come to our OPD for further evaluation and treatment.Personal Historyu Alcohol (-)u Betel quid (-)u Smoking (-)u Denied other speci
20、al habitsPast History Past Medical Historyu Denied any systemic diseaseu Drug allergy (+) : unknown Past Dental Historyu ODu Prosthesisu Tooth Extraction Full mouth scalingClinical Examinationu Fluctuation: _u Pain: _u Tenderness: +u Mobility: movableu Induration: _u Lymphadenopathy: _Extra-oralRef.
21、 6CT FindingsPetrous effectRef. 6 Features Suggestive of Benignancy1.Movable (except palate)2.Unattached to skin or mucosa (except palate)3.No ulceration of skin or mucosa4.Slow growth5.Long duration6.No pain7.No facial nerve palsy Features Suggestive of Malignancy1.Induration2.Fixed to overlying sk
22、in or mucosa3.Ulceration of skin or mucosa4.Rapid growth; Growth spurt5.Short duration6.Pain, often severe7.Facial nerve palsyRef. 6Infection or Benign / Malignantu Pain (-)u Growing slowly (56 years)u Smooth surfaceu CT findings : demarcated marginu No other structure destruction Benign TumorWorkin
23、g Diagnosesu Pleomorphic Adenoma u Warthins Tumor u Basal Cell Adenomau OncocytomaPleomorphic Adenomau 53% 77% of parotid tumorsu Painless, slow growing, firm massu Facial palsy & pain are rareu Age: 30 50 y/o u Slight female predilectionWarthins Tumor u Occurs almost exclusively in the parotid glan
24、du 5 % 14 % of parotid tumorsu Slow-growing, nodular massu Firm to fluctuant to palpationu Bilateral occurrence (5-14%)u Age: older adults, 51-70 y/ou Associated with smoking Basal Cell Adenomau Parotid (75%) 1st , minor glands 2nd (esp. upper lip, buccal mucosa)u Age: middle-aged、older adults、6170
25、(most)u Sex predilection: female ( female : male = 2:1 in some study)u Slow growing, freely movable mass, similar to pleomorphic adenomau Most tumors are less than 3 cm in diameteru 1% of all salivary gland tumorOncocytomau Painless, slow growing, u Firm mass rarely 4cmu 80% in parotid glandu Older
26、adults, 7180 (peak)u Slight female predilectionu Occurrence: 1% of all salivary gland tumoru Pleomorphic Adenoma, right parotid glandClinical ImpressionExcisional BiopsyRef. 6Excisional BiopsyRef. 6Excisional BiopsyRef. 6Excisional BiopsyRef. 6Pleomorphic adenomaRt parotid glandHistopathological Dia
27、gnosisRef. 2Mass of specific location Masses in median-paramedian region Submental lymph nodes: enlargement - Infection: lymphoid hyperplasia : acute lymphadenitis - metastatic cervical node - lymphoma Epidermoid and dermoid cyst - Do not have tongue elevationRef. 1(重要重要)Mass of specific location Ma
28、sses in median-paramedian region Thyroid gland infection-thyroiditis Acute suppurative inflammation, iodine-Hasimotos disease Autoimmune disease, sensitive to its own thyroglobulin Ref. 1Mass of specific location Masses in median-paramedian region Thyroglossal duct cyst-Arise from remnants of embryo
29、nic thyroglossal duct from tongue base to sternum-Upward thrust when protrude the tongue-Most commonly occurs below hyoid bone-Dome-shaped (重要重要)Ref. 1Mass of specific location Masses in median-paramedian region Riedels thyroiditis-A fixed & hard mass-Mimicking a malignancy Thyroid neoplasm (within
30、thyroid gland)-Benign & malignant tumor-CystRef. 1D.D. of masses in median-paramedian region 6. Ectopic thyroid gland1. Thyroglossal duct cyst2. Epidermoid/dermoid cyst3. Submental lymphadenitis4. Submental abscess5. Thyroid gland tumorRef. 36. Ectopic thyroid gland(Fig. below).Ref. 71. Intrathoraci
31、c goiter2. Esophageal fibroma4. Sarcoidosis3. Metastatic carcinomaLateral region (low-level)Ref. 33. Carotid body tumor4. Branchial cleft cyst (2nd arch)5. Cystic hygroma6. Neurofibroma2. Sialadenitis8. Hemangioma1. Salivary gland tumor7. Fibroma9. Plunging ranula10. Enlarged nodesLateral region (hi
32、gh-level)Ref. 3 Cystic hygroma-developmental benign cystic dilation of lymphatic vein at variable ages after birth-occur at any points in neck from skull base down to mediastinum-enlarges at an alarming rate causing suffocation-fluid aspirated from the mass froths readily on agitation due to high fa
33、t content lymph fluidA 26-year-old male presented with a 2-month history of a mildly painful, slow growing, nodular mass of the submental region. Extraoral examination revealed a 1.5 1.0-cm midline swelling of the submental region. The skin over the mass appeared normal. The mass was firm and slight
34、ly tender on palpation and appeared to be positioned within the submental space. Intraoral examination did not reveal any obvious pathologic findings and the nearby teeth showed no caries, periodontal disease, or mobility. The patients medical history was unremarkable.What is your differential diagnosis after studying this lecture?Ref. 8Summaries明明白白頸頸部部腫腫脹脹之之鑑鑑別別診診斷斷原原理理，並並知知道道其其中中的的應用。應用。
