Intralesional Triamcinolone for Treating Mandibular Langerhans Cell Histiocytosis: A Case Report and Literature Review

Craniofacial Langerhans Cell Histiocytosis Successfully Treated Through Intralesional Injection of Triamcinolone Acetonide: A Retrospective Study

Treatment options for single-system Langerhans cell histiocytosis (LCH) range from observation to chemotherapy. Among these options, corticosteroid injection is appealing due to the feasibility, preservation of structure and function as well as the low complication rate. Therefore, this study aimed to investigate the effectiveness of intralesional injection of triamcinolone acetonide (TA) for the treatment of craniofacial LCH and present a typical case. 11 patients diagnosed with LCH of the jaws who received intralesional injection of TA at Hospital of Stomatology, Sun Yat-sen University from April 2014 to May 2021 were involved. Clinicopathologic data were collected and analyzed. The 11 subjects included 7 males and 4 females (mean age 14.6±16.9 y). Most lesions were located in the mandible (n=9, 81.8%). The effective rate of intralesional injection of TA was 90.9%. The average initial dosage and average accumulative dosage were 33.2±21.0 and 99.5±88.7 mg, respectively. The mean time needed for complete ossification of the lesion was 12.5±8.2 months. The mean follow-up time was 20±13.4 months. Although the effective rate was similar between children and adults (100% versus 75%, P=0.364), the initial dosage, accumulative dosage, number of injections, and time needed for complete ossification of the lesion were all lower in children (P<0.05). In conclusion, intralesional injection of TA is a suitable treatment option for craniofacial LCH, especially in children. Studies that incorporate a larger patient cohort should be conducted to verify the current findings.

Incidental Diagnosis on Orthopantomography of Langerhans Cell Histiocytosis with Multifocal Jaw Involvement: A Case Report of Single-System Disease

BACKGROUND Langerhans cell histiocytosis (LCH) is a relatively rare neoplasm with a strong inflammatory component. It has diverse clinical manifestations, which range from a single lesion or multiple bony lesions to severe multisystem involvement. Approximately 10% to 20% of cases of LCH occur in the jaw, with the posterior mandible being the site most frequently involved. CASE REPORT We report on the case of a 42-year-old man who presented with bilateral osteolytic lesions in the posterior mandible that were incidentally discovered during routine radiographic screening. Histological examination of the specimen confirmed the diagnosis of LCH. CONCLUSIONS This case illustrates the importance of orthopantomography (OPG) as a screening tool in new patients to perform an overall evaluation of the teeth and surrounding structures, such as the bone, temporomandibular joint, and sinuses. Moreover, OPG can be used to screen for the presence of asymptomatic lesions that are often diagnosed incidentally on radiographs.