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口腔病理學 陳玉昆副教授 : 高雄醫學大學 口腔病理科 07-3121101~2755 Preliminary Diagnosis of Oral Lesions (1) 口腔病灶之初步診斷 (1)

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Presentation on theme: "口腔病理學 陳玉昆副教授 : 高雄醫學大學 口腔病理科 07-3121101~2755 Preliminary Diagnosis of Oral Lesions (1) 口腔病灶之初步診斷 (1)"— Presentation transcript:

1 口腔病理學 陳玉昆副教授 : 高雄醫學大學 口腔病理科 ~2755 Preliminary Diagnosis of Oral Lesions (1) 口腔病灶之初步診斷 (1)

2 Understanding: 1. 口 腔 診 斷 及 口 腔 病 理 介紹 2. Conditions produce exophytic lesions 學 習 目 標學 習 目 標

3 1. Van der Stelet PF. Dent Clin North Am 2000;44: Kaohsiung Medical University, Oral Pathology Department 3. 自購網路資源: super_toolcool References: 參考資料

4 口 腔 診 斷 及 口 腔 病 理 介 紹口 腔 診 斷 及 口 腔 病 理 介 紹 頭頸部 口 腔 診 斷 Refs. 1, 3

5 口 腔 診 斷 Real-time polymerase chain reaction (RT-PCR) Refs. 1, 3 口 腔 診 斷 及 口 腔 病 理 介紹

6 口 腔 診 斷 A 40 y/o female suffered from 37 toothache for 3 months No other abnormal mucosal lesion was noted Diagnosed her symptoms as periodontitis Prosthetic crown of 37 was removed to perform endodontic tx Dentist A Refs. 1, 2, 3 口 腔 診 斷 及 口 腔 病 理介紹

7 口 腔 診 斷 Severe pain of tooth 37 was still persisted Severe pain of tooth 37 was still persisted Dentist B The post extraction The post extraction wound remained unhealed wound remained unhealed Referred her to visit KMU Referred her to visit KMU dental dept for further tx dental dept for further tx Tooth 37 was extracted Tooth 37 was extracted Refs. 1, 2, 3 口 腔 診 斷 及 口 腔 病 理 介紹

8 口 腔 病理 Biopsy— 活體切片檢查 病 理 診 斷病 理 診 斷 Refs. 1, 3 口 腔 診 斷 及 口 腔 病 理 介紹

9 口 腔 病理 Extraction Extraction of tooth 37 of tooth 37 Dentist C 切片檢查 病 理 診 斷病 理 診 斷 口腔癌 Refs. 1, 2, 3 口 腔 診 斷 及 口 腔 病 理 介 紹口 腔 診 斷 及 口 腔 病 理 介 紹

10 口 腔 診 斷 及 口 腔 病 理介 紹 口 腔 病 理 學 病 理 診 斷病 理 診 斷 口 腔 診 斷 學 臨 床 診 斷臨 床 診 斷 一 體 的 兩 面一 體 的 兩 面 牙科放射線影像學 口腔組織學 Ref. 3

11 Conditions produce exophytic lesions Hyperplasia-dilantine hyperplasia Hypertrophy-tongue (muscle) Pooling of fluid-pus, mucocele, cyst Neoplasia-tumor What is the difference between hyperplasia & hypertrophy ? Ref. 2

12 Hyperplasia/Hypertrophy Exophytic lesions Lingual Tonsil Lymphoid aggregates Follicle Geminal center Refs. 2, 3

13 Hyperplasia/Hypertrophy Exophytic lesions Circumvallate Papillae Buccal Papillae Orifice of Stensen duct Refs. 2, 3

14 Hyperplasia/Hypertrophy Exophytic lesions Exostosis/Tori Refs. 2, 3

15 Hyperplasia/Hypertrophy Exophytic lesions Inflammatory Hyperplasia Irritating chronic injury inflammation Formation of granulation tissue (endothelial cells, capillary bed, round cells & fibroblasts) Refs. 2, 3

16 Hyperplasia/Hypertrophy Exophytic lesions If etiology is eliminated Subside Inflammatory Hyperplasia If not, granulation increases & fibrosis occurs pales, pink, smooth firm lesion (irritating fibroma) Refs. 2, 3

17 Hyperplasia/Hypertrophy Exophytic lesions Pyogenic Granuloma Granlomatous stage: red, soft, easily bleeding Mixed stage: red with pink color Fibrosis: light pink & firm to palpation (fibroma or fibroid epulis) Refs. 2, 3

18 Hyperplasia/Hypertrophy Exophytic lesions Pyogenic Granuloma -- D.D. Pregnancy tumor Epulis granulo- matosum Exophytic capillary hemangioma Ulcerative peripheral giant cell granuloma Peripheral odontogenic tumor Kaposi sarcoma Abscess Refs. 2, 3

19 Hyperplasia/Hypertrophy Exophytic lesions Epulis Fissuratum Due to unfit denture Refs. 2, 3

20 Papillary Hyperplasia Hyperplasia/Hypertrophy Exophytic lesions Beneath a denture Usu. <0.3cm Nicotinic stomatitis Refs. 2, 3

21 Epulis Granulomatosum Hyperplasia/Hypertrophy Exophytic lesions Malignant tumor from extraction wound (X-ray-bone destruction) Arising from extraction socket Pulp Polyp Refs. 2, 3

22 Mucocele/Ranula Pooling of fluid Exophytic lesions Ranula Mucocele Soft, bluish, dome (nodular)-shaped, painless exophytic mass/swelling Refs. 2, 3

23 Cyst Formation Pooling of fluid Exophytic lesions Incisive canal cyst Soft, pinkish, dome-shaped, painless exophytic sessile mass/swelling with smooth surface Refs. 2, 3

24 Pus discharge/Sinus tract Pooling of fluid Exophytic lesions Gutta Percha point Refs. 2, 3

25 Neoplasia/Tumor Exophytic lesion Hemangioma Firm, bluish, dome-shaped, smooth-surfaced painless exophytic mass/swelling Irregular surface Refs. 2, 3

26 Neoplasia/Tumor Exophytic lesion Lymphangioma Fissure tongue There is an irregular (rough) surface, firm, painless swelling, measured about 3x4cm in dimension, consisting of multiple reddish small nodules over the dorsal tongue Refs. 2, 3

27 Neoplasia/Tumor Exophytic lesion Ameloblastoma There is a well-defined, smooth surface, firm, tender swelling, measured about 3x4cm in dimension, over the right cheek. It is covered with normal appeared skin without hyperemia (hot feeling) Refs. 2, 3

28 Neoplasia/Tumor Exophytic lesion Odontoma- Compound type Refs. 2, 3

29 Neoplasia/Tumor Exophytic lesion Papilloma/Verrucous Hyperplasia Refs. 2, 3

30 Neoplasia/Tumor Exophytic lesion Exophytic Squamous Cell Carcinoma Reddish-whitish Ulcerative There is an ulcerative, firm, painful, tender, reddish, indurated swelling, measured about 3x4cm in dimension, over the anterior border of tongue Round shaped crater-like Left lateral border Refs. 2, 3

31 Neoplasia/Tumor Exophytic lesion Exophytic Squamous Cell Carcinoma Refs. 2, 3

32 Neoplasia/Tumor Exophytic lesion Exophytic Squamous Cell Carcinoma—D.D. Pyogenic granuloma Malig salivary gl tumor Peripheral malig CT tumor Verrucous ca Peripheral meta tumor Refs. 2, 3

33 Summaries Knowing: 1. 口 腔 診 斷 及 口 腔 病 理學 2. The various conditions produce exophytic lesions


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