Eosinophilic granuloma: resolution of maxillofacial bony lesions following minimal intervention. Report of three cases and a review of the literature.
BACKGROUND
Langerhans' cell histiocytosis is a collective term used to describe a group of enigmatic proliferative disorders. The natural history of the disease varies from a slow, benign, localized symptomatic bony or soft tissue lesion, to a rapidly progressive widespread multiple organ disorder which is often fatal. Eosinophilic granuloma accounts for 60-70% of all cases of Langerhans' cell histiocytosis and can present as solitary (50-75%) or multifocal defects in bone. It occasionally presents as a localized soft tissue lesion. There are multiple treatment options but the response is unpredictable.


OBJECTIVE
We present three separate cases, of the maxillofacial skeleton where the lesions of eosinophilic granuloma resolved following incisional biopsy only.


RESULTS
Three patients presented with solitary lesions of the maxillofacial skeleton. All were diagnosed as Langerhans' cell histiocytosis following open curettage, which also resulted in resolution of the lesions. Follow-up has thus far been disease free.


CONCLUSIONS
For some solitary Langerhans' cell histiocytosis lesions, simple curettage is the only treatment required. The paper discusses the need to confirm the solitary nature of the disease and the need for follow-up. Reviewing the literature on the disease, the authors suggest that perhaps cellular immaturity holds the cells of the lesion in a disease state until pushed to maturity by the trauma of open curettage surgery, resulting in a complete resolution of the disease.
Key
Steven J
SJ
Department of Maxillofacial Surgery, St Georges Hospital, Tooting, London, UK. stevenj.key@virgin.net
O'Brien
Ciaran J
CJ
Silvester
Keith C
KC
Crean
St-John
SJ
D001706:Biopsy; D001847:Bone Diseases / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003475:Curettage; D004803:Eosinophilic Granuloma / Q000473:pathology*; D005147:Facial Bones / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006646:Histiocytosis, Langerhans-Cell / Q000473:pathology; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000473:pathology; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009916:Orbital Diseases / Q000473:pathology; D012074:Remission Induction; D013705:Temporomandibular Joint Disorders / Q000473:pathology