患者姓名：陳冠宇 出生日期：1998/03/30 年齡性別：26/M 病歷號碼：9044649
Chief Complaint:
I went to local dental clinic for a checkup and was diagnosed with cyst over right jaw.
I was referred to TSGH OS OPD for further evaluation
Present Illness:
The patient, a 26-year-old male, native Taiwanese, went to local dental clinic for a checkup and was diagnosed with cyst over right jaw.
He was then referred to TSGH OS OPD for further evaluation.
After physical and imaging examinations, cyst of right mandible (suspect OKC) and deep caries/periodontitis of 46 was noted.
Therefore, he was arranged admission for surgical treatment.
Past History:
Systemic disease: HTN (denied); DM (denied); heart disease (denied); HBV (denied); HCV (denied); GU (denied); DU (denied); TB (denied); COPD (denied); CVA (denied); asthma (denied)
Operation History (or Trauma):
None of this kind of history.
Personal History:
Occupational history: pet shop
Alcoholic drinking: denied
Betel nut chewing: denied
Cigarette smoking: 2 cigarettes per day for 2 years
Allergy: NKA
Traveling history: no traveling history within 3 months
Marital Status: married
Education: University
Family History:
As family pedigree.
Allergy History:
No history of allergy.
Drug Resistance:
No history of drug resistance.
Psychological Assessment:
生理：右側下顎牙齦腫痛
心理：配合治療
家庭：家庭健全
靈性：無特殊信仰，生活舒適
Review of Systems:
General: no weight change, no fever, no chills
Skin: no hair nail change, no rash, no itching
Head: slight asymmetric appearance due to local swelling, no trauma
Eyes: have vision glasses, no blurring, no diplopia, no scotomata
Ears: no hearing loss, no tinnitus, no vertigo
Nose: no epistaxis, no obstruction, no postnasal drip
Mouth: no mouth opening limitation
Pulmonary. no wheezing, no sputum, no chest pain
Breast: no mass, no discharge, no pain
Cardiovascular: no orthopnea, no cyanosis, no palpitation
Gastrointestinal: no vomiting, no abdominal pain, no jaundice, no bleeding
Genitourinary: no dysuria, no incontinence
Sexual history: no sore discharge
Endocrine: no heat intolerance, no cold intolerance
Bone, joint, muscle: no pain, no cramps
Blood, lymphatic: no bruising, no lymph node enlargement
Neurologic: normal sensation, speech clear
Physical Examinations:
2024-06-29 22:5
血壓：137/96mmHg 耳溫：36.2℃ 脈搏：87次/分 呼吸18次/分
2024-06-29 22:43 昏迷指標：E4V5M6
2024-06-29 22:43 昏述指標：EAVSM5
BH: 169 cm BW: 62 kg
OS Findings:
Extraoral findings: normal
Intraoral findings: cyst over right jaw (suspect OKC), about 2.3 cm in diameter.
Gingival redness and swelling over lower right posterior region was noted.
X-Ray Data:
PANO findings:
Missing of 11 18 21 28 37 47
Previous RCT: 22 46
Prosthesis: nil
Cyst over right jaw (suspect OKC), about 2.3 cm in diameter
Impression:
Cyst of right mandible, suspected odontogenic keratocyst.
Deep caries of 46 with periodontitis and odontogenic infection
Diagnostic Plans:
Collect B/R, E-8, electrolytes examinations and serology tests
Chest X-ray (P-A view)
Panoramic radiographic examination
Arrange CNCT to check condition of cyst
Therapeutic Plans:
Pain control and control the inflammatory conditions with medication.
Full mouth scaling with ultrasonic device.
Arrange surgical intervention of teeth extraction, debridement and cyst enucleation under general anesthesia to reduce the risk of infection.
Educational Plans:
Explained the current conditions and treatment plan to the patient and family.
Well explained to the patient and patient's family about the surgery procedure.
Oral hygiene instructions.
Post operative care.
Odontogenic Keratocyst (OKC):
好發族群與部位：10-40歲女性的下顎後牙區
成因：源於dental lamina；與PTCH基因有關
症狀：較大成長能力且增生速度快，顎骨中以前後的方向生長；針抽吸有棕色cheesy material或黃綠色澄清液（keratin）
影像學：邊界清楚的multilocular RL包裹一顆阻生齒，使原始位置缺牙
病理組織學：與primordial cyst相同
未發炎
Rete pegs消失，有薄（6-8層）、均勻厚度的lining epi.；最靠近cavity的細胞有parakeratin且呈波浪狀；有立方或柱狀的basal cell呈柵狀排列；cyst wall中有小的cyst稱daughter cyst
發炎
上皮parakeratin消失，且變厚形成rete ridge；basal cell的柵狀排列消失
預後：易復發（30％）
相關syndrome：
Nevoid basal cell carcinoma syndrome
(= basal cell nevus syndrome = Gorlin syndrome)
成因：9th 體染色體顯性遺傳，PTCH基因異常
症狀：
顎骨中多發odontogenic keratocyst (OKC)
大腦鐮鈣化
神經疾病，如胼胝體發育不全
基底細胞癌
眼距變大
皮膚上皮囊腫
手、腳掌小凹窩
女性卵巢腫瘤
脊柱彎曲、肋骨分叉
診斷：有5個major criteria，分別為多發性OKC、大腦鐮鈣化、B.C.C.、手、腳掌小凹窩與一等親友N.B.C.C. syndrome
