please answer me the differential diagnosis is possible

[takashis]

Female 32 ys ,
CC: hard palate is swelling about 5 month
medical history:
sinusinusitis about 5 year,no treatment,no drug use
and allergic rhinitis,no drug allergy normal blood pressure
Dental history
:extract 26 but swelling isn't relief
Exraoral examination:
normal
Intraoral examination:
good oral hygiene
swelling on left hard palate,dome shape,smouth surface,pale pink of mucosa
( I have attact picture patient and OPG)
Please tell me about Differential diagnosis
thank you so much
takashi kendo ,dentist student,thailand

http://image.ohozaa.com/show.php?id=c5a051a8dc7aa1a54477a19a123bfc8a
http://image.ohozaa.com/show.php?id=739762b6de69ff1202e7d9c693c4a7be

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[mrswinidm]

Interesting case. I would recommend to have a good quality PAs and of course biopsy. The palatal swellings can be most commonly salivary gland neoplasms. How does the swelling feel? I mean hard, firm, cystic or soft. Depending on that you can have all sort differentials. From the available information, pleomorphic adenoma and mucoepidermoid carcinoma are the top two. Please keep posted. I am really interested in this case and thanks for sharing.

 

[lifeisgood]

The upper left first molar was probably extracted with the assumption that it was the cause of a periapical lesion. It should not be ruled out that the cause of the swelling could be caused by 27 (ISO Designation system). I have seen many cases where the PARL was caused by an adjacent tooth and not the one immediately next to lesion.

However, you really need more information than what was given (i.e. better radiographs, check for presence of sinus tract & trace with gutta percha if found, ask patient if they have been experiencing a bad taste in their mouth which could indicate the presence of a draining fistula, etc).

The fact that the swelling is fairly slow growing indicates it is most likely a benign or reactive lesion (like the periodontal infection described above). Assuming a salivary gland tumor and the fact that there are only minor salivary glands in the palate, the most likely diagnosis is a pleomorphic adenoma (or mixed tumor) as mrswinidm had suggested. About half of all minor salivary gland tumors are PA's and about 55% of those arise in the palate.

Due to the slight bluish coloration, I would include other possible diagnoses including those of vascular origin. Some might include a mucocele (salivary), hemangioma, vascular leiomyoma (more common on tongue but also found on the palate), etc.

Basically you need more information than you included here otherwise the differential will be very long and all over the place.