title: Isolated Langerhans Cell Histiocytosis Bone Lesion in Pediatric Patients: Systematic Review and Treatment Algorithm.
abstract: OBJECTIVE
  The present study reviewed all cases reported of isolated Langerhans cell histiocytosis bone lesions in the head and neck of pediatric patients. The objective was to create a treatment algorithm to facilitate the diagnosis and management of these lesions.
  
  
  METHODS
  Eligible articles were identified through a comprehensive search of the following electronic databases: PubMed, Ovid Medline, Embase, and Cochrane Library.
  
  
  METHODS
  Two authors independently reviewed the titles and abstracts retrieved by the electronic search concordant with the criteria for study eligibility. The lists of articles from each author were jointly reviewed and a common list created. All relevant articles were reviewed in hard copies and as full texts to justify inclusion.
  
  
  RESULTS
  A total of 201 patients (67% male, mean age: 8.1 ± 4.3 years) were included from 45 studies. Clinical presentations included swelling (64%), pain (9%), or both (18%). The skull (61%) and the orbit (24%) were the most common location for isolated bone lesions in the head and neck. The most frequently documented management option was resection, followed by observation, chemotherapy, and intralesional steroid injection.
  
  
  CONCLUSIONS
  Due to its rarity and variability in presentation and severity, treatment of these lesions has yet to be standardized. Based on the review, a diagnosis and treatment algorithm was created for head and neck surgeons when encountering these types of lesions.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Aren
authors.initials: A
authors.lastname: Bezdjian
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Abdullah A
authors.initials: AA
authors.lastname: Alarfaj
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Namrata
authors.initials: N
authors.lastname: Varma
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada sam.daniel@mcgill.ca.
authors.forename: Sam J
authors.initials: SJ
authors.lastname: Daniel
mesh_terms: D000465:Algorithms; D001847:Bone Diseases / Q000628:therapy*; D002648:Child; D003131:Combined Modality Therapy; D019468:Disease Management; D006646:Histiocytosis, Langerhans-Cell / Q000628:therapy*; D006801:Humans
keywords: Langerhans cell histiocytosis; bone lesion; head and neck; systematic review; unifocal