CASE REPORTS   

Italian Journal of Maxillofacial Surgery 2014 December;25(2-3):75-80

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Langerhans cell histiocytosis: a case report and rehabilitation with zygoma implants and Toronto bridge

Bertolai R. ¹, Conti M. ¹, Maio V. ², Giannini D. ¹

¹ Unit of Maxillofacial Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy; ² Unit of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy

Langerhans cell histiocytosis (LCH) represents a group of rare disorders histologically characterized by the presence of a mixed infiltrate with Langerhans cells in affected tissues. The disease may have a local or a systemic multi-organ evolution. Typically bone involvement is present and, less frequently, lesions can also develop in lungs, liver, lymph nodes, skin and mucous membranes. Oral soft tissues without jaw bones involvement are very rare. The AA report a case of a 50-year-old patient who came to observation for the clinical evaluation of chronic erythematous and swollen lesions in the oral mucosa. The lesions were neither ulcerated nor painful. Intraoral examination showed a distinct pathologic mobility of teeth and periodontal lesions with diffuse bone resorption, especially in the mandibular body, as confirmed by OPT and CT. Histological examination confirmed the diagnosis of LCH. The patient underwent surgery, both the maxillary and the jaw, with enucleation of the lesion and curettage of the bone. The severe atrophy of the mandible and maxilla, subsequent pathology and surgery, was due to instability of the total prosthesis so it was decided to insert four zygomatic implants in the maxillary and 5 endo-osseous implants in the jaw and apply a Toronto bridge after two days. Development of lesions in the oral mucosa with severe and rapid horizontal bone resorption, and osteolytic areas of inflammatory origin, may be one of the first manifestations of LCH. Histological examination, OPT and CT help in the correct classification of the disease. Therefore the dentists are a key figures in the early recognition of this disease.