Purpose : The aim of the study was to present the cranifacial manifestations of eosinophilic granuloma with the review of the features , the choice of the method of treatment and the outcome of the disease.Patients and Methods : We present 5 cases with the most common clinical presentations of intraoral swelling and loose teeth. The lesions were located at the maxilla and mandible . One patient had an ulcerative lesion at the temporal region of the scalp. The radiologic view showed lytic lesions at the scalp and maxilla-mandibular area. All of the patients had an incisional biopsy with the diagnosis of "Langerhans cell Histiocytosis".Results : The choice of treatment was curettage in all patients and radiotherapy was combinated in one patient. Postoperative follow-up of the patients showed no recurrenceConclusion : Intraoral lesions located at the maxilla and mandible associated with the loose teeth should be biopsied for the diagnosis of eosinophilic granuloma. Introduction Eosinophilic granuloma (EG) of bone may be defined as a benign , well-localized solitary or multiple osseous lesions characterized by large number of eosinophils and Langerhans type histiocytes(1,2,3). It is first described by Lichtenstein and Jaffe in 1940 (1,4,5). Independently of them , Otoni and Ehrlich described cases showing the same type of the lesion under the name of “solitary granuloma of bone”. It is now known that the disease process may be present not only in one bone but in several or even many bones , so the designation “solitary granuloma” is already inappropriate (5).Eosinophilic granuloma is classified as one of a triad of nonlipid reticuloendothelial disorders; Histiocytosis X disease which may be described as a nonneoplastic , proliferative disorder of histiocytes of unknown aetiology (6,7). EG differs from Hand-Schüller-Christian disease and Letterer-Siwe disease in that it is a less agressive disease process, confined to bone, occurs later in life and demonstrates an abundance of eosinophils (1,2,4,5,6,7,8). Hand-Schüller-Christian disease which is the chronic disseminated histiocytes includes bone lesions, Diabetes Insipidus and exophtalmia (1,7). Another dimension of the disease spectrum is an acute systemic illness named as Letterer-Siwe disease. It occurs mainly in infants and young children with a rapidly fatal course manifesting itself in multiple organs (1,7).EG is the least severe and most common form of Histiocytosis X. It can affect any bones with the exception of those of hands and feet (2,3). It is more common in the pelvis, ribs, skull, vertebrae, facial bones, femur, tibia and jaws (1,2,5). The jaws are affected in 10%-20% of all EG cases. The posterior mandibular region is the most frequently affected site (9). Materials And Methods We would like to present 5 cases whose ages range from 4 years to 44 years.The most common clinic presentation was intraoral swelling and mass.Some of them also complained of loose teeth, tenderness and fetor oris.One patient had an ulcerative lesion located at the temporal region of the scalp.The laboratory findings were normal.The panoramic radiograph showed lytic lesion in the mandible.The craniography of the patient with the temporal lesion showed cranial bone destruction. Four year old patient had nuclear bone scanning with Tc 99m which revealed increased uptake of the radionuclide in the mandible.All of the patients had an incisional biopsy with the diagnosis of “Langerhans cell Histiocytosis”. A visceral ultrasonography and radiological skeletal survey showed no evidence of multifocal soft tissue or skeletal involvement. The choice of treatment was curettage. Postoperative follow-up of them showed no recurrence.
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