Vanishing Mandible: A Rare Case Report with Accent to Recent Concepts on Aetio-pathogenesis

Clinical features and current management experience in Gorham-Stout disease: a systematic review

BACKGROUND

Gorham-Stout disease (GSD) is a rare complex lymphatic malformation. Since its initial description in 1838, only approximately 400 patients have been documented. There is currently no consensus on the diagnostic criteria or treatment options for GSD. The objective of this study was to review the clinical characteristics of patients with GSD and determine the current diagnostic and treatment models.

METHODS

A comprehensive search of the PubMed, Web of Science, Embase, and Cochrane Library databases was conducted to identify all relevant literature on GSD published over the decade from 2013 to 2023. The clinical information extracted from these publications was analyzed.

RESULTS

A total of 206 patients with GSD were included in the study, comprising 119 males, 81 females and 6 patients with unknown sex. The age of onset of patients was widely distributed, ranging from 0 to 77 years old. However, the majority of cases occurred in childhood (50.7%). Fifteen patients (10.3%) exhibited an onset age of less than 1 year. The average time from the onset of symptoms to diagnosis was 3.5 years. The number of patients with osteolysis in the axial bone was greater than that in the appendiceal bone (P < 0.05), and the number of patients with multiple osteolytic lesions was greater than that with single osteolytic lesions (77.2% vs. 22.8%). In general, GSD was more likely to occur in the spine (46.1%), ribs (28.6%), hip (23.3%), femur (18.4%), mandible (15.5%) and humerus (15.0%). Pain was the most common symptom, with 68.4% of patients reporting pain in the lesion area. Surgery (66.9%) and bisphosphonates (56.9%) are still the mainstream treatment methods, with a total of 33 (18.2%) patients receiving sirolimus. Pleural effusion was identified as a risk factor for patient mortality (P < 0.05).

CONCLUSIONS

GSD is most commonly observed in children, with a slight male predisposition. It commonly manifests as multiple osteolysis of the axial bone, with pain being the most common symptom. The presence of pleural effusion indicates a serious condition that requires close monitoring to prevent mortality. Despite the advent of novel therapeutic modalities, the management of GSD remains an area in need of further investigation.

Vanishing bone disease: An enigma

Vanishing bone disease is a rare clinical entity with unknown etiology. This disease affects individual irrespective of age or sex. Various names have been used in the literature to describe this condition such as Gorham's disease, phantom bone disease, massive osteolysis, disappearing bone disease and acute spontaneous absorption of bone. The pathogenesis is unknown and the treatment still remains controversial. Considering the rarity of the disease, we report here an interesting and unique case of massive osteolysis of the lower jaw that affected the mandibular basal and alveolar bone. The diagnoses lead on the association of clinical, radiological and histological features.

Floating teeth appearance: A radiographic dilemma

Gorham disease (GD) is an extremely rare disorder that is characterised by massive osteolysis of the affected bone with unknown aetiology and an unpredictable prognosis. Additionally, no standard treatment is available for GD. This article describes a case report of a 61-year-old Malay woman who was diagnosed with GD of the anterior mandible without a prior history of trauma. She presented with pain and mobility of the dentoalveolar segment for 3 months. The radiographic findings showed “floating teeth” with widening of the periodontal ligament space and localized area of bony destruction. Histopathologically, there was proliferation of numerous dilated endothelial-lined channels within the intertrabecular tissue. Some areas of bone were replaced by fibrous connective tissue giving rise to the appearance of a benign fibroosseous lesion. The patient was managed with simple removal of the affected bone segment under local anaesthesia, followed by prosthodontic rehabilitation. Healing of the surgical site was uneventful, and no recurrence was reported at the 3-year follow-up.