PMC5769776_01
A perforation of the ulcer was observed in the gum on the bottom right jaw.
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Gross examination revealed perforation of an ulcer in the gum on the bottom right of the jaw (Figure 1).
Radiograph showing the bone transmission of the lower right jaw, floating teeth, and a pathological fracture of the mandible body. CT scan shows a cystic lesion on the same site as the pathological fracture.
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An X-ray showed a bone transmission image in the lower right jaw, floating teeth and a severe pathological fracture of the mandibular body (Figure 2). A computed tomography scan showed a cystic lesion on the same site as the pathological fracture (Figure 2).
MRI scan shows low signal on T1-weighted images and high signal on T2-weighted images.
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A magnetic resonance imaging (MRI) scan showed a low signal on T1-weighted images, and a high signal on T2-weighted images (Figure 3).
Haematoxylin-eosin staining indicating infiltration of eosinophils. The Langerhans cell-like cells in the periphery were S100 protein positive. The Langerhans cell-like cells in the periphery were CD1a positive.
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Immunohistochemical staining was S100 protein positive and CD1a positive (Figure 4); therefore, the diagnosis was LCH.
Mandible segmental resection and reconstruction by a free fibula flap were performed.
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Therefore, the diagnosis was LCH confined to the mandible, and a mandibular segmental resection and reconstruction using a free fibula flap was performed (Figure 5).
One month after the operation, intermaxillary fixation was performed to obtain a normal occlusion. No recurrence was observed more than two years after surgery.
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Normal occlusion was acquired, and no recurrence was observed more than two years after surgery (Figure 6).