RESUMEN
INTRODUCTION: Langerhans cell histiocytosis is a rare disease. When it occurs in the cranium/facial bones, the mandibular location is the most frequent. PRESENTATION OF CASE: A 31 years-old man was referred to our department for a mandibular chronic discomfort during an acute exacerbation, spontaneous teeth mobility and an alteration of the dental occlusion revealing a pathologic mandibular fracture.The diagnosis was confirmed by a subsequent CT scan.The surgical procedure was performed under general anesthesia by a maxillo-facial senior surgeon. The therapeutic plan combined teeth extractions, enucleation of both the left maxillary and right mandibular cystic lesions and osteosynthesis of the pathologic mandibular fracture with a miniplate.Histological and immunohistochemistry analysis of the maxillary and mandibular cystic lesions pointed the diagnosis of a bifocal Langerhans cell histiocytosis of the oral cavity.Several investigations were done in order to find another location, showing no abnormalities. DISCUSSION: This is a case of rare single system LCH at two distinct locations: one at the mandibular bone and the other at the upper left maxilla. Both were uncovered by an acute exacerbation of a chronic discomfort secondary to a mandibular pathologic fracture. This should draw attention to the issues of the diagnosis. CONCLUSION: An early LCH diagnosis and a multidisciplinary treatment plan allow the improvement of the patient 's prognosis and quality of life.
RESUMEN
INTRODUCTION: Congenital hypoplasia of the depressor anguli oris muscle is a rare mimic disorder depicted by a lower lip asymmetry apparent when laughing or crying. PRESENTATION OF CASE: A 10-year-old boy consulted our department for an asymmetry when opening his mouth. According to the family, this asymmetry was present since birth. Perinatal characteristics and childhood medical history were investigated with no abnormalities. Physical exam revealed an inability to draw down the right lower lip unilaterally. At rest position, facial asymmetry was not noticeable. Several investigations were done: A CT scan of the petrous part of the temporal bone, an MRI of soft tissues, an electromyography and a heart ultrasound. No anomalies were found. DISCUSSION: This condition has stimulated great interest because of its potential association with congenital anomalies but also in order to reassure families often worried by the situation. A large therapeutic armamentarium is described in literature. CONCLUSION: Among the large armamentarium of therapeutic options, we opted for a wait and see strategy through photographic smile tracking leading to an evidence of Asymmetric crying faces over time improvement.