PMC8357521_01
(a) Gingival ulcer proliferative growth in relation with the restored right maxillary molars. (b) 2D panoramic radiograph showing the unilocular radiolucency in the maxilla and the mandible. (1) Axial images of the CT scan exposed the presence of radiolucency in the maxilla with cortical bone deterioration. (d) axial images of the CT scan displaying a well-defined localized radiolucency in the body of the mandible. (e) The excised tissue after tooth extraction. (f) Histopathology of Langerhans cell histiocytosis: prominent histiocytes with abundant cytoplasm against the background of mixed population of eosinophils and multinucleated giant cells (HE x10).
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In the maxilla, a gingival ulcer proliferative growth in relation to the restored right molars was observed with a mobility type II (Figure 1(a)). In the left side of the mandible, two well-defined radiolucencies were noted, the first in relation to the mesial root of the first molar and the second on the mandibular body apically to the second molar (Figure 1(b)). Under loco-regional analgesia, the two teeth were extracted, and the excised tissue was sent for histological evaluation (Figure 1(e)). The result came out with an LCH diagnosis (Figure 1(f)).
(a, b) Complete body scintigraphy with Te 99 revealing the only localization of LCH lesions in the jaws. (c) Panoramic radiograph after teeth extractions.
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Bone scintigraphy was completed and confirms that the lesions are limited in the right maxilla and on the left mandible (Figures 2(a) and 2(b)).
(a) Custom-made rigid mask. (b) Patient wearing the stabilisation mask. (c) 3D treatment planning is done using the CT scan images.
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The objective of the custom-made rigid mask is to stabilize the head during the radiotherapy sessions (Figures 3(a) and 3(b)). 3D treatment planning is prepared using the CT scan images fed into the planning system (Figure 3(c)).
One-year follow-up after the end of RT treatment: (a) panoramic radiograph; (b) maxillary soft tissue healing; (c) mandibular soft tissue healing.
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Complete remission was achieved clinically and radiologically after one year (Figures 4(a)-4(c) ).
5-year follow-up radiographs: (a) panoramic radiograph; (b) sagittal CBCT image showing complete bone healing in the maxilla; (c) sagittal CBCT image showing complete bone healing in the mandible.
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