Mandibular lesions in gaucher disease

506

ORAL SURG ORAL MED ORAL PATHOL October 199 1

Radiology forum

MANDIBULAR

LESIONS

IN GAUCHER

DISEASE

A

40-year-old Jewish woman came to the Newcastle Dental Hospital with a complaint of bleeding gums. The medical history revealed that the patient had Gaucher disease, for which a splenectomy had been performed 28 years previously. It was also found that she had recently had a nonspecific viral infection and that treatment had been received from her general medical practitioner. Several hemorrhagic lesions were seen on the face and lips, a finding consistent with Gaucher disease. Intraoral examination revealed only a generalized, chronic, edematous

gingivitis with spontaneous bleeding after gentle probing. A panoramic radiograph showed bilateral, generalized areas of increased radiopacity in the premolar and molar regions of the mandible (Fig. 1) . These areas did not extend beneath the inferior dental canal. Other findings were an unerupted maxillary cuspid with extensive coronal resorption (Fig. 2) and generalized horizontal bone loss of about half-root length. Red cell, platelet, and hemoglobin counts were all within normal limits. There was, however, a marked leukocytosis with an inverse neutrophil/lymphocyte ratio. Serum biochemistry revealed that the calcium, phosphate, and alkaline phosphatase levels were within normal limits. Discussion

Fig. 1. Panoramic radiograph showing areas of increased radiopacity related to all mandibular premolar and molar teeth.

Fig. 2. Periapical radiograph resorption of maxillary cuspid.

showing extensive coronal

Several reports have documented mandibular radiolucencies due to marrow infiltration by Gaucher cells.1-6 There has, however, been no report of mandibular radiopacities occurring in Gaucher disease, although temporary bone regeneration followed splenectomy and extraction of teeth in a case documented by Bender.’ In the present case, the radiopacities could represent a chronic diffuse osteosclerotic type of reaction to an initial Gaucher cell infiltration. The leukocytosis was not consistent with the usual hematologic findings in this disorder, although a repeated white blood cell count showed that this was temporary and a possible reaction to a viral infection. The serum calcium, phosphate, and alkaline phosphatase levels excluded the possibility of a coincidental fibro-osseous disorder such as Paget disease of bone. P. A. Heasman Section of Periodontology Department of Operative Dentistry Dental School University of Newcastle upon Tyne Newcastle upon Tyne NE 24BW United Kingdom REFERENCES 1. Tassman GC, Bender IB. Gaucher disease. Report of a case. J Am Dent Assoc 1940;27:1268-70. 2. Moth WS. Gaucher disease with mandibular bone lesions. ORAL SURG ORAL MED ORAL PATHOL 1953;6:1250-4. 3. Shira RB. Manifestations of systemic disorders in the facial bones. J Oral Surg 1953;11:286-307. 4. Spiegel LW. Gaucher disease. ORAL SURG ORAL MED ORAL PATHOL 1957;10:158-66. 5. Michanowicz AE, Michanowicz JP, Stein GM. Gaucher disease. ORAL SURG ORAL MED ORAL PATHOL 1967;23:36-42. 6. Browne WG. Oral pigmentation and root resorption in Gaucher disease. J Oral Surg 1977;35:153-5. 7. Bender IB. Dental observations in Gaucher disease. A twentyyear follow-up. ORAL SURG ORAL MED ORAL PATHOL 1959; 12:546-61.