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Orocutaneous fistula (OCF) (of dental origin) is an uncommon but well-described condition in the literature. These are often misdiagnosed by physicians and dentists. Careful selection of investigating modality is important in case of diagnostically challenging cases. A 19-year-old female came with a complaint of a lesion on the chin reported with h/o trauma with the impact on chin presented as diagnostic dilemma because of unusual case history and clinical examination. Commonly used radiographic investigations like IOPA and orthopantomograph did not resolve the dilemma whereas advanced imaging modality like CT scan, 3D volume imaging, and contrast enhanced CT played an important role in the diagnosis of OCF and selecting the treatment plan.

Langerhans cell histiocytosis (LCH) is a group of rare disorders histologically characterized by the proliferation of LC, involving multiple organs and systems. Typically, there is bone involvement and, less frequently, lesions may be found in the lungs, liver, lymph nodes, skin, and mucosae. Oral soft tissue lesions without bone involvement are rare. Antigenic markers that react with CD1a glycoprotein, cytoplasmatic protein S100 detected by immunoperoxidase staining, and/or presence of Birbeck granules on electron microscopic examination are required for a definitive diagnosis of LCH. In this article, we report a case of LCH, which had presented with multiple oral lesions without any other systemic signs and symptoms. Management of such children with periodontal manifestations should include hematological and, if possible, immunological investigations at an early stage. Careful clinical examination, good diagnostic skill, and awareness of characteristic cytological features of LCH can lead to earlier diagnosis and treatment with minimal deformity.