Marcucci Marcelo, Serrano Rafael Verardi, Campos Luana, Palma Luiz Felipe
Stomatology and Oral and Maxilofacial Surgery Center, Hospital Heliópolis, São Paulo, SP, Brazil.
Graduate Dentistry Program, Ibirapuera University, São Paulo, SP, Brazil.
Natl J Maxillofac Surg. 2022 May-Aug;13(2):294-297. doi: 10.4103/njms.njms_19_22. Epub 2022 Jun 15.
Many aggressive non-endodontic radiolucent lesions show very similar clinical and radiographical features to periapical lesions of endodontic origin. Since the treatments of endodontic and non-endodontic lesions differ markedly, a precise diagnosis is imperative. Thus, the present study aimed at presenting a clinical case on the diagnosis and management of a Langerhans cell histiocytosis (LCH) lesion mimicking a periapical lesion of endodontic origin. A 51-year-old male patient was referred to a private dental office due to slight pain from the region of tooth 36. Although no sign of prosthetic or endodontic failure was noted, radiographical examination revealed a radiolucent image with poorly defined borders associated with the periapical region of the tooth. Apicoectomy and bone curettage were then performed and, given the clinical and laboratory features, the definitive diagnosis of solitary eosinophilic granuloma was made. The surgical treatment was sufficient for the remission of the symptoms, and recurrence was not observed. Given the current case, dentists should be aware of LCH lesions as they may mimic endodontic periapical pathoses, leading to misdiagnosis and therapeutic complications. Moreover, alveolar bone lesions may be the first or only sign of LCH in many cases.
许多侵袭性非牙髓性透射性病变在临床和影像学特征上与牙髓源性根尖周病变非常相似。由于牙髓性和非牙髓性病变的治疗方法明显不同，精确诊断至关重要。因此，本研究旨在呈现一例朗格汉斯细胞组织细胞增多症（LCH）病变的诊断和处理病例，该病变酷似牙髓源性根尖周病变。一名51岁男性患者因36号牙区域轻微疼痛被转诊至一家私人牙科诊所。尽管未发现修复或牙髓治疗失败的迹象，但影像学检查显示在该牙根尖周区域有一个边界不清的透射影像。随后进行了根尖切除术和骨刮治术，并根据临床和实验室特征，确诊为孤立性嗜酸性肉芽肿。手术治疗足以缓解症状，且未观察到复发。鉴于当前病例，牙医应意识到LCH病变，因为它们可能酷似牙髓性根尖周病变，导致误诊和治疗并发症。此外，在许多情况下，牙槽骨病变可能是LCH的首个或唯一迹象。
