[Eosinophilic granuloma of the mandible--a case report].
BACKGROUND
Langerhans cell histiocytosis is characterized by a clonal proliferation of Langerhans cells. The clinical manifestation varies from a localized lesion (eosinophilic granuloma) to a systemic disease. The diagnosis can only be confirmed histopathologically. A comprehensive staging is necessary to determine the extent of the disease and to establish an adequate therapy.


METHODS
We report on a 27 years old patient who was referred to our clinic with the diagnosis of an osteomyelitis of the mandibular angle and a pathological fracture after extraction of tooth 38 one month before. Curettage and primary bone grafting were performed. In the histological examination of the specimen infiltrates of a Langerhans cell histiocytosis were found. The clinical and radiological staging demonstrated a solitary mandibular lesion (eosinophilic granuloma). After wound healing a low-dose radiotherapy with 6 Gray was performed. Two years after completion of the therapy the patient is asymptomatic and does not show any evidence of recurrence.


CONCLUSIONS
Langerhans cell histiocytosis has to be included in the differential diagnosis of osteolytic lesions of the mandible. A low-dose radiotherapy is a reasonable and well-tolerated treatment option.
Klinik für Mund-, Kiefer-, Gesichtschirurgie, Oralchirurgie, Luzerner Kantonsspital, CH-6000 Luzern 16. cornelia.helbling@ksl.ch
Cornelia
C
Helbling-Sieder
Jan-Olaf
JO
Gebbers
Johannes
J
Kuttenberger
D000328:Adult; D001860:Bone Plates; D016025:Bone Transplantation; D003937:Diagnosis, Differential; D004803:Eosinophilic Granuloma / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D008337:Mandibular Fractures / Q000209:etiology; D019647:Oral Surgical Procedures / Q000379:methods*; D010014:Osteolysis / Q000175:diagnosis; D010019:Osteomyelitis / Q000175:diagnosis; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods; D014081:Tooth Extraction / Q000009:adverse effects