Indian Journal of Cancer Medknow Publications on behalf of Indian Cancer Society ISSN: 0019-509X EISSN: 1998-4774 Vol. 48, Num. 2, 2011, pp. 262-264

Indian Journal of Cancer, Vol. 48, No. 2, April-June, 2011, pp. 262-264

Letter to Editor

Implant retained prosthetic rehabilitation in the case of histiocytosis X of the mandible

KP Dholam¹, HA Pusalkar¹, KH Kapadia²

¹ Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Dr. E. Borges Road Parel, Mumbai, India
² Department of Oral Maxillofacial Surgery, D. Y. Patil Dental College, Mumbai, India

Correspondence Address: K P Dholam Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Dr. E. Borges Road Parel, Mumbai India kdholam@rediffmail.com

Code Number: cn11065

DOI: 10.4103/0019-509X.82888

Sir,

Histiocytosis X, a name suggested by Sichenateen (for Langerhans cell histiocytosis) in 1953, is a disorder of the reticuloendothelial system. ^[1] It is a disease of unknown etiology characterized by the proliferation of pathological Langerhans cells. It is a rare pediatric disease of unknown etiology affecting one to five children per one million each year, adult cases have also been reported. ^[2] The head and neck region is affected in 90% of the cases. ^[3]

The incidence of oral manifestations of Langerhans cell histiocytosis (LCH) with oral lesions has been reported to be as high as 77%. The prognosis of a patient with the localized form of this disease is excellent. This is a case presentation of Histiocytosis X of the mandible and its dental rehabilitation.

A 12-year-old male reported with a history of a diffuse, nontender, hard swelling on the left mandibular and submandibular region since a year. Level III nodes were palpable (2 x 2 cm ² ). An Orthopantomograph (OPG) showed multiple osteolytic lesions [Figure - 1]. A skeletal survey revealed a lytic lesion in the frontoparietal region with osteopenia in the calvarial bones. Focal scalloping of the outer table of the skull vault in the left frontoparietal region was seen on a magnetic resonance imaging (MRI) scan. The bone scan presented with an increased concentration on the body and ramus of the left mandible. The rest of the skeleton was normal. The genetic anomaly factor was not seen in either the immediate or distant family members.

Meticulous curettage of the mandibular granuloma was completed. The pathological fracture of the outer table of the mandible was noted.

The patient was given three cycles of chemotherapy (Etopsiode and methyl prednisolone) with concurrent local radiotherapy (2000 Gy). The skull lesion was considered as quiescent and not radiated. The patient showed good response to the treatment. The OPG showed a new bone formation and healing of the fractured border of the mandible. The lingually tilted mandibular left second molar was set in an upright position orthodontically. On the patient attaining 16 years of age, an implant-retained fixed bridge was planned [Figure - 2].

Three Cylindrical Implants [(3.5 x 8 mm) x 1, (3.5 x 10 mm) from Hi-tec implants Ltd., Galgalei Plada, St. Industrial zone, Herzlia, Israel PO box 2022, Herzalia 46722] were placed [Figure - 3]. ^[4] After a six-month healing period, the implants were exposed and healing caps were attached [Figure - 4]. The prosthetic phase was completed after one month. Impression posts and implant analogs were attached on the implant [Figure - 5]. Additional silicone impressions were made and the die stone models were prepared for fabricating the wax pattern, for metal casting. A metal trial was done [Figure - 6]. Jaw relations and a face-bow transfer were recorded and the models were mounted for fabrication of the ceramic superstructure. The finished metal-ceramic restoration was tried in the patient′s mouth to check the fit. Occlusal adjustments were conducted to achieve a stable occlusion. The metal ceramic restoration was cemented [Figure - 7] and oral hygiene instructions were given to the patient, with follow-up every six months.

Osseointegrated implants play a major role in functional oral rehabilitation. ^[5] The goal of treating any disease is to control and cure the disease process and rehabilitate the patients, so they can continue their normal functions as far as possible, thus contributing to their quality of life.

References

Copyright 2011 - Indian Journal of Cancer

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