Langerhans cell histiocytosis (eosinophilic granuloma) .

  • Langerhans cell histiocytosis includes three clinical forms:
    • Eosinophilic granuloma: is the localized form of the disease (usually in children and young adults)
    • Hand-Schuller-Christian: is the chronic, widespread form of the disease
    • Leterrer-Siwe: is the  malignant, acute and widespread form of the disease (children under 3 years old).
  • Of the above clinical forms eosinophilic granuloma, whether single or multiple, is often found in the jaws.
  • Most often the lesions are located either periapical or peri-radicular to the teeth and usually are misinterpreted as periapical granulomas and cysts or as  periodontal disease.
  • Radiographically the lesions are radiolucent with somewhat irregular or ill defined borders and have the  tendency to extend deeper in the medullary bone.
  • Computed tomography images, show perforation and destruction of the cortical plates or the floor of the nasal and maxillary sinus cavities. In a short period of time, loss of bony support, mobility or  apoptosis  of the adjacent teeth are observed.

Differential Diagnosis

Case 1

The second panoramic image was taken six months later. At the beginning  the disease was misdiagnosed and treated, as periodontitis

Case 2

Langerhans cell histiocytosis in the mandible.

Case 3

Langerhans cell histiocytosis in the maxilla.(same patient as above).

Case 4

Langerhans cell histiocytosis in upper and lower jaw.