Multifocal Langerhans cell histiocytosis in an adult with a pathological fracture of the mandible and spontaneous malunion: A case report.

Langerhans cell histiocytosis (LCH) is rare in the adult population and even rarer with jaw involvement. The current study presents the case of a 39-year-old male who complained of recurrent pain, swelling of the gingiva and an occasional pus-like discharge in the right mandible for one year. The patient was previously prescribed antibiotics, but this did not resolve the problem. An initial panoramic radiograph showed an osteolytic lesion and bone fracture in the right mandible. Eight months later, a new radiograph showed the spontaneous malunion of the fractured mandible. The patient was eventually diagnosed with Langerhans cell histiocytosis by histopathology and immunohistochemistry. Further lesions were found in the ribs and ilium by nuclear bone scanning. The patient was subsequently treated with systemic chemotherapy, and the lesions are currently effectively being controlled. This study is the first to show that spontaneous intralesional bone regeneration may lead to reunification of the mandible fracture caused by LCH in an adult.

Enucleation combined with peripheral ostectomy: its role in the management of large cystic ameloblastomas of the mandible.

AIM: Aggressive resection of a large mandibular cystic ameloblastoma may cause severe deformity and dysfunction, while simple enucleation may carry a high risk of recurrence. The purpose of this study was to evaluate, in terms of both recurrence and the preservation of contour and function, the effectiveness of enucleation combined with peripheral ostectomy (Enu/PO) in managing large mandibular cystic ameloblastomas. MATERIALS AND METHODS: Fourteen patients who had large mandibular cystic ameloblastoma (11 unicystic, 3 multicystic) and had been treated with the Enu/PO were reviewed. RESULTS: The follow-up period was 19-117 months. Using Enu/PO, mandibular continuity was preserved in all patients, and only one patient complained of permanent lip numbness. With bone regeneration, the thinned bone plate significantly thickened and the residual cavity shrank. No pathological fracture occurred. There was recurrence in 3 patients. Two recurrences were treated with radical surgery, and the other with Enu/PO. No new recurrence was found thereafter. All patients were satisfied with their facial appearance. CONCLUSIONS: The Enu/PO technique is excellent in preserving appearance and functions and with a low risk of recurrence, is a reliable option for the management of large mandibular cystic ameloblastomas.

Periodontal parameters and platelet-activating factor levels in serum and gingival crevicular fluid in a Chinese population.

AIM: Platelet-activating factor (PAF) is a potent proinflammatory mediator and has been implicated in cardiovascular pathophysiology. The present clinical study assessed the relation between the severity of periodontal disease and PAF levels in gingival crevicular fluid (GCF) and serum. METHODS: A total of 60 non-smoking subjects (21 periodontitis, 19 gingivitis patients and 20 healthy individuals) were included. Probing depth, attachment level, bleeding on probing, plaque index and sulphide levels were recorded at six sites of each tooth. GCF and blood samples were collected from all individuals, and PAF levels were investigated by enzyme-linked immunoabsorbent assay. RESULTS: The periodontitis group showed significantly higher PAF levels in the serum (329.3+/-287.3 pg/ml) and GCF (21.8+/-7.0 pg/sample) compared with the gingivitis group (138.0+/-77.9 pg/ml, 13.8+/-3.6 pg/sample) and with healthy controls (68.9+/-42.8 pg/ml, 2.4+/-2.7 pg/sample). The differences between patients and controls were statistically significant (p