BackgroundBone necrosis of the jaw is a serious condition with a broad differential diagnosis of pathologies such as cutaneous histiocytosis, bone metastases or malignant tumours. In addition to the most common cause, medication related osteonecrosis of the jaw (MRONJ), one must consider a number of other causes, such as histiocytosis.Langerhans cell histiocytosis (LCH) is a histiocytic disorder with a large spectrum of clinical manifestations and with possible involvement of a variety of organs. This case shows the importance of an early detection of this rare disease in order to prevent further spreading. Even if an initial diagnosis in the oral cavity is rare, dentists should be aware of this disease.Case presentationThe presented case describes a patient who was referred for evaluation and treatment due to exposed bone and extensive osteolysis in the region of the upper and lower jaw. After biopsy and diagnosis of LCH, the patient was treated with systemic therapy, achieved remission and is disease free after a 2 year of follow up.ConclusionsThis case report illustrates that when dealing with unclear osteolytic changes of the jawbone, Langerhans cell histiocytosis must be taken into consideration in the differential diagnosis and biopsy must be performed in case of suspicion.

BackgroundThere are few studies measuring the dimensions of the maxillary sinus, being mostly based on computed tomography imaging and rarely being based on cone-beam computed tomography (CBCT). The aim of this study was to measure the 3D osseous and soft tissue defined volume and surface area of the maxillary sinus. Further, possible associations with patient-specific and sinus-related variables were evaluated.MethodsA total of 128 maxillary sinuses in 64 patients were analyzed using cone-beam computed tomography data. Surface area and volume of the osseus maxillary sinuses as well as of the remaining pneumatized cavities in cases of obliterated sinuses were calculated by the implant planning software SMOP (Swissmeda AG, Baar, Switzerland). Further, patient-specific general variables such as age, gender, and dentition state as well as sinus-related factors including apical lesions, sinus pathologies, and number of teeth and roots communicating with the maxillary sinus were recorded.ResultsFor osseus bordered sinuses, mean surface area was 39.7 cm2 and mean volume 17.1 cm3. For the remaining pneumatized cavities, mean surface area was 36.4 cm2 and mean volume 15 cm3. The calculated mean volume of obliterated sinuses (42.2% of all sinuses were obliterated) was 5.1 cm3. Further, an association between the obliterated volume and the presence of pathologies was detected. Male patients showed a significantly higher mean osseus volume compared to female patients. No association was apparent between a patient’s age or dentition state and sinus volume, nor for communicating tooth roots and sinus pathologies or unilateral opacity and apical radiolucency. There was also no significant association between bilateral obliterated sinuses and the scan date being in autumn/winter.ConclusionsThe present study showed that the CBCT is suitable for the evaluation of the maxillary sinus. The implant planning software SMOP and its included volume measuring tool are valuable for the analysis of the maxillary sinus, and possible relations with the dentition can be analyzed.

A case of diffuse tracheo-bronchial amyloidosis in a 62-year-old woman thought to have chronic bronchitis is reported. The immunological mechanism in the pathogenesis of this condition is considered and the need for bronchological investigation in chronic bronchial disorders is stressed. Two years ago blood-stained sputum appeared during the acute attacks. Physical examination showed a thin, elderly woman with a pulse rate of 110/minute. Scattered wheezes were heard over both lung fields, but no signs of upper respiratory stenosis were present. The first heart sound at the apex was sharp and loud and, on exercise only, a diastolic murmur grade 1 or 2 in 4 was heard. Rhythm was normal. Sputum cultures were nega-307 on 11 May 2018 by guest. Protected by copyright.