Intralesional corticosteroid therapy for mandibular Langerhans cell histiocytosis preserving the intralesional tooth germ

Abstract

Local surgical interventions continue to be central to the range of accepted therapeutic measures. However, the increasing numbers of reports on the successful treatment of solitary LCH by intralesional corticosteroid injection suggest that this treatment option should be considered especially in children to preserve tooth germs.

Langerhans cell histiocytosis: Current concepts in dentistry and case report

“…In general, available treatment options include combinations of surgical removal of localized bone lesions, chemotherapy and radiation ( 6 ). Diverse agents (immunosuppressant agents, immune modulators, and cytostatic agents) have been employed, such as corticosteroids, antibiotics, prednisonevinblastine combination, vincristine sulphate, indomethacin, methotrexate, cyclophosphamide, indomethacin, adrenocorticotropic hormone (ACTH), etoposide, and 6-mercaptopurine ( 26 , 27 ); or therapeutic procedures, such as interferon or cyclosporine-A, bone marrow transplant, monoclonal anti-CD 1a antibody therapy, and gene transfer into hemopoietic progenitor or stem cells ( 26 ). Treatment of the disease depends primarily on a careful multidisciplinary evaluation and correct diagnosis.…”

“…Thus, in stages I and II, when only the bone or only the soft tissues are involved, the treatment is solely surgical. In stage III, a combination of chemotherapy, radiation (in recommended doses of 6 Grays to 15 Grays), and pharmacotherapy ( 1 , 26 ). However, in young pediatric patients, especially in those under 5 to 6 years of age, radiation therapy may seriously affect the developing teeth and craniofacial bones, as well as adversely affect the intellectual development; hence, radiation therapy is not suggested as the first-choice treatment in young children.…”

“…Additionally, in LCH stage III cases, there is a long-term 1-5% risk of secondary malignancy, such as lymphoma, acute leukemia or solid tumors ( 10 ). Therefore, a more conservative drug therapy is preferred, for instance, intralesional corticosteroids ( 26 ); however, this approach may occasionally delay the root development of those teeth close to the osteolytic lesion ( 29 ).…”

Isolated Langerhans Cell Histiocytosis Bone Lesion in Pediatric Patients

“…Following independent then joint review of titles and abstracts, 122 articles were selected for full review. Forty-five 8-52 of these were chosen for data extraction, from which 201 pediatric patients were identified with isolated bone lesion in the head and neck with specified management ( Figure 1 ).…”