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Bony Canal Method of Dexamethasone Injections in Aggressive Form of Central Giant Cell Granuloma-Case Series. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020250. [PMID: 36837452 PMCID: PMC9961085 DOI: 10.3390/medicina59020250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/30/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023]
Abstract
Central Giant Cell Granuloma constitutes approximately 7% of benign tumors of the jaws. The aggressive form of CGCG clinically behaves like a classic semi-malignant neoplasm. In the literature, the suggested method of treatment of aggressive forms of CGCG is curettage or resection with the margin of 0.5 cm. Surgical treatment, especially in the developmental age, entails disturbances in the growth and differentiation of tissues and deforms and disturbs the functioning of the stomatognathic system. Alternative treatment methods of the CGCG presented in this article lead to the patient avoiding a mutilating procedure and improve their quality of life. The aim was to present alternative method of treatment of aggressive forms of Central Giant Cell Lesion of the jaws-injections of dexamethasone into the tumor mass through drilled bony canals. Here, we present the three cases of aggressive forms of CGCG of jaws treated with dexamethasone injections into the tumor mass. Two cases resulted in regression of the tumor, which was confirmed in histologic evaluation after remodeling surgery. Those two patients were uneventful and showed no signs of tumor recurrence at 8 and 9 years of thorough follow-up, respectively. The third patient was qualified for the mandible resection due to the enlargement of the lesion and destruction of the cortical bone. According to our observations, if the proper patient discipline, and thorough, careful clinical and radiological examinations are provided, the dexamethasone injections could be a recommended method of treatment of intraosseous giant cell granuloma. The indication is restricted to the cases with preserved bony borders despite deformation. Additionally, leaving vital teeth in the lesion is also possible.
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Sclerostin Immunohistochemical Staining in Aggressive Maxillofacial Giant Cell Lesions: Initial Results and Potential Therapeutic Target. J Craniofac Surg 2021; 33:790-793. [PMID: 34753866 DOI: 10.1097/scs.0000000000008344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Maxillofacial (MF) giant cell lesions (GCLs) are benign, often locally aggressive lesions with potential for recurrence. Systemic treatments have included interferon alpha, calcitonin, bisphosphonates, and denosumab. Sclerostin (SOST) is typically thought to be a negative regulator of bone metabolism and anti-SOST agents have been used to treat osteoporosis; however, its role in central giant cell granuloma is unknown. The purpose of this study was to evaluate the expression of SOST in MF GCLs. MATERIALS AND METHODS This was a retrospective study of patients with MF GCLs treated at a single institution between 1993 and 2008 with a minimum follow-up of 6 months. Representative tissue was used to create a tissue microarray and SOST immunohistochemical (IHC) staining and grading was performed. The primary outcomes were IHC staining of the stromal cells and giant cells. The secondary outcomes included correlation of IHC staining and patient predictor variables including clinically benign and aggressive lesions. All analyses were completed using univariate statistical tests. RESULTS A total of 37 subjects were included (29 clinically aggressive and 8 clinically benign). Sclerostin staining was present in 30 of 37 subjects (81%). Of these, 22 (60%) had stromal cell staining and 28 (76%) had giant cell staining. The presence or absence of staining, of either cell type, was not associated with aggressiveness, presence of clinical symptoms, tumor size, previous interferon therapy, previous surgery, or the race or age of the patient. DISCUSSION Maxillofacial GCLs have an overall high level of SOST staining; however, the role of SOST in treatment and prognosis is unknown and warrants further study.
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Schreuder WH, van der Wal JE, de Lange J, van den Berg H. Multiple versus solitary giant cell lesions of the jaw: Similar or distinct entities? Bone 2021; 149:115935. [PMID: 33771761 DOI: 10.1016/j.bone.2021.115935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/27/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023]
Abstract
The majority of giant cell lesions of the jaw present as a solitary focus of disease in bones of the maxillofacial skeleton. Less frequently they occur as multifocal lesions. This raises the clinical dilemma if these should be considered distinct entities and therefore each need a specific therapeutic approach. Solitary giant cell lesions of the jaw present with a great diversity of symptoms. Recent molecular analysis revealed that these are associated with somatic gain-of-function mutations in KRAS, FGFR1 or TRPV4 in a large component of the mononuclear stromal cells which all act on the RAS/MAPK pathway. For multifocal lesions, a small group of neoplastic multifocal giant cell lesions of the jaw remain after ruling out hyperparathyroidism. Strikingly, most of these patients are diagnosed with jaw lesions before the age of 20 years, thus before the completion of dental and jaw development. These multifocal lesions are often accompanied by a diagnosis or strong clinical suspicion of a syndrome. Many of the frequently reported syndromes belong to the so-called RASopathies, with germline or mosaic mutations leading to downstream upregulation of the RAS/MAPK pathway. The other frequently reported syndrome is cherubism, with gain-of-function mutations in the SH3BP2 gene leading through assumed and unknown signaling to an autoinflammatory bone disorder with hyperactive osteoclasts and defective osteoblastogenesis. Based on this extensive literature review, a RAS/MAPK pathway activation is hypothesized in all giant cell lesions of the jaw. The different interaction between and contribution of deregulated signaling in individual cell lineages and crosstalk with other pathways among the different germline- and non-germline-based alterations causing giant cell lesions of the jaw can be explanatory for the characteristic clinical features. As such, this might also aid in the understanding of the age-dependent symptomatology of syndrome associated giant cell lesions of the jaw; hopefully guiding ideal timing when installing treatment strategies in the future.
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Affiliation(s)
- Willem H Schreuder
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek / Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Jacqueline E van der Wal
- Department of Pathology, Antoni van Leeuwenhoek / Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Henk van den Berg
- Department of Pediatrics / Oncology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
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Khavanin N, White MJ, Walsh JM, Steinberg JP. Mandibular Reconstruction Following Central Giant Cell Granuloma Resection in Primary Dentition: A Case for the Use of a Costochondral Graft. Cleft Palate Craniofac J 2020; 58:260-268. [PMID: 32757776 DOI: 10.1177/1055665620946985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Central giant cell granuloma is a benign, intraosseous lesion that may affect the pediatric craniofacial skeleton, particularly the mandible. When surgery is indicated, the role of the craniofacial surgeon is to ameliorate the sequelae of ablative surgery by restoring facial symmetry, ensuring appropriate postoperative occlusion, and allowing for adequate interincisal opening, all in the setting of a growing craniofacial skeleton. Herein, we report the case of a 3-year-old female presenting for reconstruction after resection of the right hemimandible proximal to the unerupted first permanent molar. We highlight the various reconstructive challenges associated with mandibular reconstruction during primary dentition and make a case for the use of a costochondral graft, with a successful outcome demonstrated at 2 years of follow-up.
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Affiliation(s)
- Nima Khavanin
- Department of Plastic and Reconstructive Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marissa J White
- Department of Pathology, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan M Walsh
- Department of Otolaryngology-Head and Neck Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jordan P Steinberg
- Department of Plastic and Reconstructive Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Smriti K, John E, Pentapati KC, Gadicherla S, Bhagania M. Intra-Lesional Medicaments for the Management of Intra-Osseous Lesions of Maxilla and Mandible - Systematic Review. J Int Soc Prev Community Dent 2020; 10:36-45. [PMID: 32181219 PMCID: PMC7055339 DOI: 10.4103/jispcd.jispcd_295_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022] Open
Abstract
Aims and Objectives: This study aimed to review the success or remission of intralesional medicaments in the management of intraosseous lesions in the oral cavity. Materials and Methods: A comprehensive search was performed in two databases (PubMed and Scopus). Research articles, case reports, case series, and clinical trials were included. Review articles, lesions not involving the bone, incomplete reporting, any other treatment other than intralesional medicaments to treat intraosseous bone lesions, publications without any treatment, and letter to editor were excluded. Data on remission (complete, partial, or no remission), details and regimen of the intervention, number of participants, and follow-up in months were recorded. Results: A total of 653 publications were available for title and abstract screening after the removal of duplicates. Seven articles were excluded, which were not in English. After title and abstract screening, a total of 88 publications were available for full-text screening. Fifty-five articles were included in qualitative synthesis. A total of 168 patients from 55 publications were evaluated. Minimum follow-up was 1 month and maximum was 264 months. More than two-third (n = 38) of the publications were case reports on single patient. More than two-third (n = 38) of the publications had complete remission. Conclusion: Intralesional medications have shown variable success rates. Extensive lesions may undergo intralesional medications followed by surgical management.
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Affiliation(s)
- Komal Smriti
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Evit John
- MPH Candidate, School of Public Health, University of Texas Health Sciences Centre, Houston, Texas, USA
| | - Kalyana-Chakravarthy Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Srikanth Gadicherla
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Manish Bhagania
- Oral and Maxillofacial Surgery, Boston University, Boston, MA, USA
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de Mendonça RP, Mitre GP, Real FH, da Silva Kataoka MS, de Melo Alves Júnior S, Vianna P, Da Silva Júnior NG, de Jesus Viana Pinheiro J. Central Giant Cell Granuloma Treated with Intralesional Corticosteroid Injections and Bisphosphonates: A Long-Term Follow-Up Case Study. Head Neck Pathol 2019; 14:497-502. [PMID: 31297738 PMCID: PMC7235135 DOI: 10.1007/s12105-019-01053-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/06/2019] [Indexed: 12/11/2022]
Abstract
Central giant cell granuloma (CGCG) is a benign intraosseous lesion of the head and neck with potential for aggressive and locally destructive behaviour. Lesions of the maxilla tend to expand more than those of the mandible due to the thinner cortices and spongy tissue of this location. Surgical removal is the most common treatment; however, it may be disfiguring in aggressive cases, especially for lesions located in the maxilla. Alternative treatments, such as intralesional corticosteroid injections, have been performed with satisfactory results. We report a case of a 12-year-old female patient with a CGCG of the left maxilla that was treated with 40 doses of intralesional triamcinolone acetonide infiltrations combined with alendronate sodium and calcium carbonate. Clinical and imaging follow-up over 12 years demonstrates improvement in the patient's condition.
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Affiliation(s)
- Raíssa Pinheiro de Mendonça
- Department of Oral Pathology, School of Dentistry, Federal University of Ceara, Rua Monsenhor Furtado, Fortaleza, Ceara 60430-355 Brazil
| | - Geovanni Pereira Mitre
- Department of Oral Pathology, School of Dentistry, Federal University of Para, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | - Flavio Henrique Real
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Para, Avenida Augusto Correa, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | - Maria Sueli da Silva Kataoka
- Department of Oral Pathology, School of Dentistry, Federal University of Para, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | - Sérgio de Melo Alves Júnior
- Department of Oral Pathology, School of Dentistry, Federal University of Para, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | | | - Newton Guerreiro Da Silva Júnior
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Para, Avenida Augusto Correa, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | - João de Jesus Viana Pinheiro
- Department of Oral Pathology, School of Dentistry, Federal University of Para, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
- Cell Culture Laboratory, Department of Oral Pathology, School of Dentistry, Federal University of Para - UFPA - Institute of Health Sciences, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
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Etoz M, Asantogrol F, Akyol R. Central giant cell granulomas of the jaws: retrospective radiographic analysis of 13 patients. Oral Radiol 2019; 36:60-68. [DOI: 10.1007/s11282-019-00380-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 02/24/2019] [Indexed: 12/28/2022]
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Huguet G, Piot B, Cassagnau E, Simon JF, Lesclous P. Rare agressive form of giant-cell granuloma: a three years follow-up case report and discussion about medical therapeutic solutions. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2018021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Central giant cell granuloma (CGCG) is a rare and benign intraosseous lesion that usually occurs in the mandible and the maxilla. It might be aggressive. Nowadays, several treatments exist. Observation: This case report, with a three years follow-up, was about an aggressive and recurring form of CGCG exclusively managed by surgical approach. Comments: Several pharmacologic approaches are possible (intralesional injections of glucocorticoids, administration of calcitonin, alpha-2a interferon, denosumab) and could be an interesting alternative or complement to the surgical management when CGCG is aggressive, recurring, or non resectable. Conclusion: Surgical approach is the gold standard for the treatment of CGCG but sometimes, pharmacologic approaches could be proposed. According to the scientific literature, denosumab appears as a reliable and effective treatment but more prospective studies are needed.
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da Rosa MRP, de Sá JL, Martins VB, de Oliveira MV. Central giant cells lesion: Report of a conservative management. Eur J Dent 2018; 12:305-310. [PMID: 29988246 PMCID: PMC6004816 DOI: 10.4103/ejd.ejd_402_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Central giant cells lesion (CGCL) is defined as a benign intraosseous destructive pathology. It is classified as aggressive or nonaggressive, depending on their clinical, imaginologic, and histological behavior. The behavior, location, and extension of the lesion added to the patient's age will determine the choice of the treatment, either surgical or clinical. Thereby, the aim of this work is to review the literature related to the CGCL, as well as to present a clinical case report of a 22-year-old female patient, affected with an injury on the left side of her jaw. After the diagnosis, it was decided to carry out a conservative treatment with intralesional injections of triamcinolone (10 mg/ml). The injections were performed once a week for 6 weeks. The progress of the patient was satisfactory, and after 4 years, it has been observed through imaging and clinical bone formation examinations with complete remission of the injury and no signs of recurrence.
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Affiliation(s)
- Marina Rolo Pinheiro da Rosa
- Resident of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Amazon State University, Manaus, Brazil
| | - Juliana Lopes de Sá
- Dentistry Student, Department of Oral and Maxillofacial Surgery, Amazon State University, Manaus, Brazil
| | - Valber Barbosa Martins
- Professor at the Residence in Maxillofacial and Traumatology Surgery, Department of Oral and Maxillofacial Surgery, Amazon State University, Manaus, Brazil
| | - Marcelo Vinícius de Oliveira
- Professor at the Residence in Maxillofacial and Traumatology Surgery, Department of Oral and Maxillofacial Surgery, Amazon State University, Manaus, Brazil
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Dos Santos B, Koth VS, Figueiredo MA, Salum FG, Cherubini K. Brown tumor of the jaws as a manifestation of tertiary hyperparathyroidism: A literature review and case report. SPECIAL CARE IN DENTISTRY 2018; 38:163-171. [PMID: 29603323 DOI: 10.1111/scd.12284] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Brown tumor of the jaws is a manifestation of hyperparathyroidism consisting of osteolytic lesions that show proliferation of multinucleated giant cells in the maxilla and/or mandible. Differential diagnosis of these lesions from local central giant-cell granuloma is mandatory for the correct treatment of the patient. Radiographic and histopathological exams of the jaw lesion are not sufficient to determine the diagnosis, which requires laboratory tests including serum levels of calcium, alkaline phosphatase, parathyroid hormone (PTH) and phosphate, and radiographic examination of other bones as well, such as hand-wrist, pelvis, and femur. We present here a brief literature review focusing on the clinical and radiographic features, diagnostic criteria and treatment of brown tumor and also report a case of the disease affecting the jaw.
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Affiliation(s)
- Bethina Dos Santos
- Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS
| | - Valesca Sander Koth
- Postgraduate Program, Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS
| | | | | | - Karen Cherubini
- Postgraduate Program, Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS
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Schreuder WH, van den Berg H, Westermann AM, Peacock ZS, de Lange J. Pharmacological and surgical therapy for the central giant cell granuloma: A long-term retrospective cohort study. J Craniomaxillofac Surg 2016; 45:232-243. [PMID: 28087284 DOI: 10.1016/j.jcms.2016.11.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 10/01/2016] [Accepted: 11/10/2016] [Indexed: 01/10/2023] Open
Abstract
PURPOSE This is a retrospective cohort study of patients with a central giant cell granuloma (CGCG) treated at a single center to assess and compare the different surgical and non-surgical approaches. MATERIAL AND METHODS A cohort with a single histologically proven non-syndrome-related CGCG was selected and reviewed. Patients were allocated to group I (surgery), group II (pharmacotherapy), and group III (pharmacotherapy and surgery). The primary outcome was long-term radiologic response using computed tomography. Secondary outcomes were intermediate radiologic responses and occurrence and severity of side effects. RESULTS Thirty-three subjects were included in the study. The surgical group (n = 4) included 1 patient with progression during follow-up and a relatively high post-surgical morbidity. Twenty-nine patients started on various pharmacological treatment regimens (groups II and III). Fourteen patients could be managed without additional surgery. One of these lesions showed progression during follow-up. The other 15 lesions underwent additional surgery, and none showed progression during follow-up. Interferon treatment was associated with the most side effects. CONCLUSION Pharmacological agents have a role in the treatment of aggressive and non-aggressive CGCGs by limiting the renewed progression during long-term follow up and the extent and morbidity of surgical treatment.
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Affiliation(s)
- Willem Hans Schreuder
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. de Lange), Academic Medical Center, Academic Center Dentistry Amsterdam and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Henk van den Berg
- Department of Pediatric Oncology, Academic Medical Center, Emma Children Hospital and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Anne Marie Westermann
- Department of Medical Oncology, Academic Medical Center and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Zachary Scott Peacock
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Fruit Street 55, MA, 02114, Boston, United States.
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. de Lange), Academic Medical Center, Academic Center Dentistry Amsterdam and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Garg P, Jain J, De N, Chatterjee K. A central giant cell granuloma in posterior part of maxilla-A case report. Int J Surg Case Rep 2016; 30:222-225. [PMID: 28089322 PMCID: PMC5985248 DOI: 10.1016/j.ijscr.2016.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/10/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Central Giant Cell Granuloma (CGCG) is an intraosseous lesion consisting of cellular fibrous tissue that contains multiple foci of hemorrhage, aggregations of multinucleated giant cells and occasionally trabeculae of woven bone1. PRESENTATION OF CASE we are presenting a case of Central Giant Cell Granuloma on Maxilla. Extra oral examination revealed a diffuse swelling on the left side of face causing slight obliteration of nasio - nasolabial labial fold resulting in facial asymmetry & Intraoral examination shows a purple expansile mass in the region of upper left 26, 27 and 28 edentulous areas. DISCUSSION Giant Cell Granuloma is a rare bony lesion in the Head and Neck region. It is a non-odontogenic tumor never seen in any other bone of the skeleton. It most commonly affects maxilla followed by the mandible. CONCLUSION There is no recurrence after a long follow up period. We concluded that conventional excision is to be considered as a best method to treat central giant cell granuloma.
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Affiliation(s)
- Priyanka Garg
- Department of the Oral & Maxillofacial Surgery, kalka Dental College & Hospital, Meerut India College of Medicine & J.N.M. Hospital, West Bengal India.
| | - Jinendra Jain
- Department of the Oral & Maxillofacial Surgery, kalka Dental College & Hospital, Meerut India College of Medicine & J.N.M. Hospital, West Bengal India
| | - Nayana De
- Department of the Oral & Maxillofacial Surgery, kalka Dental College & Hospital, Meerut India College of Medicine & J.N.M. Hospital, West Bengal India
| | - Kushal Chatterjee
- Department of the Oral & Maxillofacial Surgery, kalka Dental College & Hospital, Meerut India College of Medicine & J.N.M. Hospital, West Bengal India
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Dolanmaz D, Esen A, Mihmanlı A, Işık K. Management of central giant cell granuloma of the jaws with intralesional steroid injection and review of the literature. Oral Maxillofac Surg 2016; 20:203-209. [PMID: 26481917 DOI: 10.1007/s10006-015-0530-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 10/06/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE We report the results of the intralesional steroid injections for the management of central giant cell granuloma (CGCG) of the jaws. METHODS Seven CGCGs were treated with intralesional injection of corticosteroids. To accomplish this, 3.5 mL of triamcinolone and 3.5 mL of 0.5 % marcaine with 1/200,000 epinephrine (total 7 mL) were mixed. An adequate amount of steroid was injected into different areas of the lesion. This procedure was repeated on a weekly basis for 6 weeks. RESULTS Clinical and radiological examination showed complete resolution and ossification of the lesions in four patients. Partial recovery was achieved in two patients. One patient did not respond to the treatment and underwent surgical curettage. CONCLUSIONS We suggest that intralesional steroid injection is safe and effective for the treatment of CGCG, especially in non-aggressive lesions.
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Affiliation(s)
- Doğan Dolanmaz
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Selçuk University, Konya, Turkey
| | - Alparslan Esen
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Necmettin Erbakan University, Ankara Cd. No:75/A, Konya, Turkey.
| | - Ahmet Mihmanlı
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Bezmialem University, Istanbul, Turkey
| | - Kubilay Işık
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Necmettin Erbakan University, Konya, Turkey
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Central Giant Cell Granuloma of the Mandible Requiring Multiple Treatment Modalities: A Case Report. J Oral Maxillofac Surg 2016; 74:1596-607. [PMID: 27000410 DOI: 10.1016/j.joms.2016.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 01/04/2023]
Abstract
Central giant cell granuloma (CGCG) is a relatively rare non-neoplastic, intraosseous lesion that exhibits a wide spectrum of clinical behavior, and its management can be particularly challenging even for experienced clinicians. The etiopathogenesis of this disease process remains unclear, although factors such as trauma, inflammatory foci, and a genetic predisposition have been implicated. Although multiple treatment modalities have been used with varying degrees of success, there is no accepted algorithm for therapeutic intervention and little is known about the reasons for success or failure of a given treatment. This article reviews the epidemiology, presentation, classification, and currently used therapies for CGCG while describing the clinical course and successful therapeutic outcome of a young female patient with an aggressive CGCG of the mandible.
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Bayar OF, Ak G. Treatment of giant cell granuloma with intralesional corticosteroid injections: a case report. J Istanb Univ Fac Dent 2015; 49:45-50. [PMID: 28955545 PMCID: PMC5573504 DOI: 10.17096/jiufd.88120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/04/2014] [Indexed: 11/16/2022] Open
Abstract
Giant cell granuloma is rare in the head and
neck region and most commonly affects the maxilla
and mandible. Giant cell granulomas are benign but
occasionally aggressive lesions that are traditionally
treated with surgery. Because it is a benign process,
less radical and non-surgical treatment alternatives
are required. Corticosteroid injection is a viable
alternative in the treatment of central giant cell
granuloma to avoid surgery. We aim to present a
case which was successfully treated with intralesional
corticosteroid injection in the maxilla.
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Affiliation(s)
- Ozlem Filiz Bayar
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Turkey
| | - Gulsum Ak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Turkey
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Esen A, Işık K, Dolanmaz D. Treatment of mouth and jaw diseases with intralesional steroid injection. World J Stomatol 2015; 4:87-95. [DOI: 10.5321/wjs.v4.i2.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/11/2014] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
Many lesions of the oral region are treated with surgical methods such as curettage and resection. Chemotherapy and radiation therapy with or without surgical intervention can be used as an adjunct in some cases. Intralesional steroid injection is a conservative procedure which is already used in various regions of the body and joints. This technique is used also for a number of mouth and jaw lesions. Localized langerhans cell histiocytosis, central giant cell granuloma, oral submucous fibrosis, oral lichen planus, lichen sclerosus of the oral mucosa, lymphatic malformations and orofacial granulomatosis can be considered among these diseases. The purpose of this review is to investigate the effects of intralesional steroid injections in the treatment of oral diseases.
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Vk V, Hallikeri K, Girish HC, Murgod S. Expression of CD34 and CD68 in peripheral giant cell granuloma and central giant cell granuloma: An immunohistochemical analysis. J Oral Maxillofac Pathol 2015; 18:341-8. [PMID: 25948986 PMCID: PMC4409176 DOI: 10.4103/0973-029x.151310] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/31/2014] [Indexed: 12/03/2022] Open
Abstract
Background: Central and Peripheral giant cell granulomas of jaws are uncommon, benign, reactive disorders that are characterized by the presence of numerous multinucleated giant cells and mononuclear cells within a stroma. The origin of the multinucleated giant cells is controversial; probably originating from fusion of histiocytes, endothelial cells and fibroblasts. Objective: To assess the expression of CD34 and CD68 in central and peripheral giant cell granulomas to understand the origin of these multinucleated giant cells. Materials and Methods: Twenty cases of Central and Peripheral giant cell granulomas were evaluated immunohistochemically for CD34 and CD68 proteins expression. Results: Immunopositivity for CD34 was seen only in cytoplasm of endothelial cells of blood vessels; whereas, consistent cytoplasmic immunopositivity for CD68 was seen in few stromal cells. Statistical significance was seen in mean number of multinucleated giant cells, mean number of nuclei in multinucleated giant cells, CD68 expression and ratio of macrophages to multinucleated giant cells among two lesions. Conclusion: Although the central giant cell granulomas share some clinical and histopathological similarities with peripheral giant cell granulomas, differences in mean number of nuclei in multinucleated giant cells and CD68 immunoreactivity may underlie the distinct clinical behavior.
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Affiliation(s)
- Varsha Vk
- Department of Oral Pathology, Rajarajeswari Dental College and Hospital, Mysore, Bangalore, India
| | - Kaveri Hallikeri
- Department of Oral Pathology, Sri Dharmasthala Manjunatheshwara Dental College, Dharwad, Karnataka, India
| | - H C Girish
- Department of Oral Pathology, Rajarajeswari Dental College and Hospital, Mysore, Bangalore, India
| | - Sanjay Murgod
- Department of Oral Pathology, Rajarajeswari Dental College and Hospital, Mysore, Bangalore, India
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de Carvalhosa AA, Zandonade RMC, de Souza Castro, de Araújo Estrela CR, Borges ÁH, Estrela C. 8-Year Follow-up of Central Giant Cell Lesion Mimicking Apical Periodontitis. J Endod 2014; 40:1708-12. [DOI: 10.1016/j.joen.2014.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/18/2014] [Indexed: 10/24/2022]
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da Silva Sampieri MB, Yaedú RYF, Santos PSS, Gonçales ES, Santa'ana E, Consolaro A, Cardoso LB. Central giant cell granuloma: treatment with calcitonin, triamcinolone acetonide, and a cystic finding 3 years and 6 months after the primary treatment. Oral Maxillofac Surg 2013; 17:229-234. [PMID: 23111768 DOI: 10.1007/s10006-012-0370-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 10/18/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Central giant cell granuloma is a benign condition of the jaws which may present an aggressive behavior. CASE REPORT A 9-year-old boy was complaining of swelling in the floor of the mouth. A solid swelling was observed in the area of the lower incisors. From the radiographic exam, we observed a radiolucent image in the mandibular bone with well-defined limits extending from the apical region of tooth 33 to the apical region of tooth 42. DISCUSSION Due to the diagnosis and the age of the patient, we chose a conservative treatment, administering subcutaneous injections of calcitonin. During this treatment, no reduction to the lesion was observed. Therefore, we chose to treat the lesion with triamcinolone acetonide. Monthly follow-ups demonstrated good lesion reduction and the absence of any clinical symptoms during the first 2 years. After a 3-year follow-up, the patient returned, presenting mobility of the lower incisors. A significant increase in the size of the lesion was observed. After a biopsy, with the removal of tissue which had the appearance of a cyst capsule, microscopic analyses were found to be compatible with a secondarily infected cyst. Two months following this procedure, the patient did not present tooth mobility anymore and the oral mucosa presented a normal aspect. Following a radiographic exam, full lesion repair was observed. These conservative treatments should be the first option in cases of central giant cell granuloma and the patient must be observed for a long period of time, until no further clinical or radiographic signs of lesions are observed.
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Yanik S, Aras MH. Management of Central Giant Cell Granuloma of Mandible Using Intralesional Corticosteroids: Case Report and Review of Literature. J Oral Maxillofac Surg 2013; 71:721-2. [DOI: 10.1016/j.joms.2012.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 10/11/2012] [Accepted: 10/12/2012] [Indexed: 11/16/2022]
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Osterne RLV, Araújo PM, de Souza-Carvalho ACG, Cavalcante RB, Sant'Ana E, Nongueira RLM. Intralesional corticosteroid injections in the treatment of central giant cell lesions of the jaws: a meta-analytic study. Med Oral Patol Oral Cir Bucal 2013; 18:e226-32. [PMID: 23385503 PMCID: PMC3613330 DOI: 10.4317/medoral.18345] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/13/2012] [Indexed: 12/02/2022] Open
Abstract
Objective: The aim of this study was to evaluate the response of treatment of central giant cell lesion to intralesional corticosteroid injections.
Study Design: Review of articles indexed in PubMed on the topic between the years 1988 and 2011, and development of a descriptive meta-analysis of the results.
Results: Sample of 41 patients primarily treated with intralesional corticosteroid injections was obtained, with a male female ratio of 1:0.95, being 23 aggressive and 18 non-aggressive central giant cell lesions. Triamcinolone acetonide and triamcinolone hexacetonide were the drugs used, and 78.0% cases were considered as good result, 14.6% were considered as moderate response and 7.3% were considered as negative result to treatment. Considering the aggressiveness, 88.9% of non-aggressive lesions presented a good response to treatment, in aggressive central giant cell lesions, 69.6% presented a good response to intralesional corticosteroid injections.
Conclusion: In view of the results analyzed, intralesional corticosteroid injections could be considered as first treatment option for central giant cell lesion.
Key words:Central giant cell lesion, corticosteroids injections, triamcinolone hexacetonide, triamcinolone acetonide.
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Lee YC, Shin SY, Kim SW, Eun YG. Intralesional injection versus mouth rinse of triamcinolone acetonide in oral lichen planus: a randomized controlled study. Otolaryngol Head Neck Surg 2013; 148:443-9. [PMID: 23325710 DOI: 10.1177/0194599812473237] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the efficacy, relapse, and adverse effects between intralesional injection and mouth rinse of triamcinolone acetonide (TA) in patients with oral lichen planus (OLP). STUDY DESIGN A randomized controlled study. SETTING College medical center. SUBJECTS AND METHODS Forty consecutive patients, who had been diagnosed with OLP, were recruited. Participants were randomly divided into 2 groups using intralesional injection or mouth rinse of TA. The severity of pain and burning sensation on a 10-cm visual analog scale (VAS) and the Oral Health Impact Profile-14 (OHIP-14) were assessed at weeks 0, 1, 2, 3, 4, and 6. The signs of OLP were quantified using a special scoring system for OLP. The rate of relapse and the adverse effects were compared between both groups. RESULTS The VAS scores for pain and burning mouth sensation and objective scoring for OLP were significantly improved at 1, 2, 3, 4, and 6 weeks in both groups. The changes in the VAS for burning mouth sensation, OHIP-14, and objective scoring for OLP were similar between both groups. The change in the VAS for pain from baseline to week 1 in the intralesional injection group was significantly higher than in the mouth rinse group. The rate of adverse effects was significantly higher in the mouth rinse group than in the intralesional injection group (44.4% vs 5.0%). CONCLUSION The efficacies of both treatments were similar. The rate of adverse effects was significantly lower for intralesional injection of TA than mouth rinse of TA.
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Affiliation(s)
- Young Chan Lee
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
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Treatment of central giant cell lesions using bisphosphonates with intralesional corticosteroid injections. Head Face Med 2012; 8:23. [PMID: 22913518 PMCID: PMC3489779 DOI: 10.1186/1746-160x-8-23] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 07/18/2012] [Indexed: 01/13/2023] Open
Abstract
Central giant cell lesions are benign intraosseous proliferative lesions that have considerable local aggressiveness. Nonsurgical treatment methods, such as intralesional corticosteroid injections, systemic calcitonin and interferon have been reported. Recently, bisphosphonates have been used to treat central giant cell lesions. A case of a 36-year-old male with a central giant cell lesion crossing the mandibular midline was treated with intralesional corticosteroids combined with alendronate sodium for the control of systemic bone resorption. The steroid injections and the use of bisphosphonates were stopped after seven months when further needle penetration into the lesion was not possible due to new bone formation. After two years, the bony architecture was near normal, and only minimal radiolucency was present around the root apices of the involved teeth. The patient was followed up for four years, and panoramic radiography showed areas of new bone formation. Thus far, neither recurrence nor side effects of the medication have been detected.
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Theologie-Lygidakis N, Telona P, Michail-Strantzia C, Iatrou I. Treatment of central giant-cell granulomas of the jaws in children: Conservative or radical surgical approach? J Craniomaxillofac Surg 2011; 39:639-44. [DOI: 10.1016/j.jcms.2010.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 10/11/2010] [Accepted: 11/26/2010] [Indexed: 11/26/2022] Open
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Rachmiel A, Emodi O, Sabo E, Aizenbud D, Peled M. Combined treatment of aggressive central giant cell granuloma in the lower jaw. J Craniomaxillofac Surg 2011; 40:292-7. [PMID: 21570312 DOI: 10.1016/j.jcms.2011.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 04/03/2011] [Accepted: 04/05/2011] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aggressive type lesions of central giant cell granuloma (CGCG) require wide resection that leads to major defects in the jaws. This form of surgical treatment can be particularly disfiguring. A number of alternative non-surgical therapies have been advocated in recent years for the management of the central giant cell granuloma (CGCG). These include calcitonin injections and nasal spray, intralesional steroid injections and subcutaneous interferon injections. MATERIALS AND METHODS A large central giant cell granuloma aggressive type lesion in the mandible of a 24-year-old patient was treated successfully by intralesional injection of corticosteroid and nasal spray calcitonin that was followed by curettage with peripheral ostectomy with preservation of the continuity of the mandible and the teeth. At the 5-year clinical and radiological follow up there was no sign of recurrence. CONCLUSIONS This combined medical and surgical treatment is advantageous for large aggressive lesions in order to reduce the size of the lesion and thus minimize the need for extensive bone resection and loss of teeth that can result in functional and aesthetic defects.
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Affiliation(s)
- Adi Rachmiel
- Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Haifa, Israel.
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26
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Ferretti C, Muthray E. Management of central giant cell granuloma of mandible using intralesional corticosteroids: case report and review of literature. J Oral Maxillofac Surg 2011; 69:2824-9. [PMID: 21292370 DOI: 10.1016/j.joms.2010.11.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 11/07/2010] [Indexed: 01/13/2023]
Affiliation(s)
- Carlo Ferretti
- Division of Oral and Maxillofacial Surgery, Chris Hani Baragwanath Hospital, Soweto, Johannesburg, South Africa.
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27
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Nogueira RLM, Teixeira RC, Cavalcante RB, Ribeiro RA, Rabenhosrt SHB. Intralesional injection of triamcinolone hexacetonide as an alternative treatment for central giant-cell granuloma in 21 cases. Int J Oral Maxillofac Surg 2010; 39:1204-10. [PMID: 20674272 DOI: 10.1016/j.ijom.2010.06.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 06/03/2010] [Accepted: 06/09/2010] [Indexed: 01/13/2023]
Abstract
Central giant-cell granulomas are benign, but occasionally aggressive, lesions that traditionally have been treated surgically. 21 cases of central giant-cell granuloma of the jaw were treated with intralesional injection of corticosteroids. The treatment protocol adopted was intralesional injection of 20mg/ml triamcinolone hexacetonide diluted in an anaesthetic solution of 2% lidocaine/epinephrine 1:200,000 in the proportion 1:1; 1.0ml of the solution was infiltrated for every 1cm(3) of radiolucid area of the lesion, totalling 6 biweekly applications. Ten patients had aggressive lesions and 11 nonaggressive. Two patients showed a negative response to the treatment and underwent surgical resection, 4 showed a moderate response and 15 a good response. 8 of the 19 who had a moderate-to-good response to the drug treatment underwent osteoplasty to reestablish facial aesthetics. In these cases, only mature or dysplastic bone was observed, with the presence or absence of rare giant multinucleated cells. The advantages of this therapy are its less-invasive nature, the probable lower cost to the patient, lower risk and the ability to treat the lesion surgically in the future, if necessary.
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Affiliation(s)
- R L M Nogueira
- Department of Dental Clinic, Discipline of Oral and Maxillofacial Surgery and Stomatology, Ceará Federal School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
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28
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Tosco P, Tanteri G, Iaquinta C, Fasolis M, Roccia F, Sid Berrone, Garzino-Demo P. Surgical treatment and reconstruction for central giant cell granuloma of the jaws: A review of 18 cases. J Craniomaxillofac Surg 2009; 37:380-7. [DOI: 10.1016/j.jcms.2009.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 03/22/2009] [Accepted: 04/03/2009] [Indexed: 12/26/2022] Open
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29
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Allon DM, Anavi Y, Calderon S. Central giant cell lesion of the jaw: Nonsurgical treatment with calcitonin nasal spray. ACTA ACUST UNITED AC 2009; 107:811-8. [DOI: 10.1016/j.tripleo.2009.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Revised: 01/31/2009] [Accepted: 02/01/2009] [Indexed: 10/20/2022]
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30
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Wong YK, Cheng JCF. Central giant cell granuloma in palate associated with orthodontic treatment. ACTA ACUST UNITED AC 2008; 15:135-9. [PMID: 18826766 DOI: 10.1308/135576108785891105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A case report of a central giant cell granuloma in the palate, which arose after orthodontic treatment, is presented with a review of relevant literature. Treatment options and clinical implications are also discussed.
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Affiliation(s)
- Yiu-Kai Wong
- Oral-Maxillofacial Surgery and Dental Unit, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
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Dos Santos LAN, Campos PSF, Laranjeira AL, Bonan PRF, Martelli H, Cardoso SV. Effectiveness of computed tomography to evaluate central giant cell lesion. Dentomaxillofac Radiol 2008; 36:522-5. [PMID: 18039637 DOI: 10.1259/dmfr/26940351] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Central giant cell lesion (CGCL) is a benign disease involving the mandible (70%) more than the maxilla; it tends to be more common in women. Clinically, the lesion may be associated with pain, tooth displacement, facial asymmetry, paraesthesia and ulceration of the mucosa. The radiographic aspect of CGCL is highly variable since it may appear as a unilocular or multilocular radiolucent area with expansion and perforation of the cortical bone. Few previous reports have dealt with the usefulness of CT in the evaluation of this lesion. The purpose of this study is to report the clinical and imaging features of a case, including CT, treated by a conservative method.
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Affiliation(s)
- L A N Dos Santos
- Oral Radiology division, State University of Campinas, Sao Paolo, Brazil.
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32
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Graham RM, Foster ME, Richardson D. An Unusual Presentation of a Central Giant Cell Granuloma and Initial Treatment with Intralesional Steroids– A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2008. [DOI: 10.5005/johcd-2-3-65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
A case of a 6 year-old boy is presented with an extensive intraoral central giant cell granuloma, which was initially thought to be a lesion of odontogenic origin. Central giant cell granuloma is an unusual lesion to be found within the oral cavity. Treatment ranges from radical surgical resection to conservative approaches, such as the one presented, with intralesional steroid injections. We would agree with previous work that this as a viable treatment adjunct and possible alternative to surgery for central giant cell granuloma of the jaws.
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de Lange J, van den Akker HP, van den Berg H. Central giant cell granuloma of the jaw: a review of the literature with emphasis on therapy options. ACTA ACUST UNITED AC 2007; 104:603-15. [PMID: 17703964 DOI: 10.1016/j.tripleo.2007.04.003] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2006] [Accepted: 04/10/2007] [Indexed: 01/10/2023]
Abstract
Central giant cell granuloma (CGCG) is a benign lesion of the jaws with an unknown etiology. Clinically and radiologically, a differentiation between aggressive and non-aggressive lesions can be made. The incidence in the general population is very low and patients are generally younger than 30 years. Histologically identical lesions occur in patients with known genetic defects such as cherubism, Noonan syndrome, or neurofibromatosis type 1. Surgical curettage or, in aggressive lesions, resection, is the most common therapy. However, when using surgical curettage, undesirable damage to the jaw or teeth and tooth germs is often unavoidable and recurrences are frequent. Therefore, alternative therapies such as injection of corticosteroids in the lesion or subcutaneous administration of calcitonin or interferon alpha are described in several case reports with variable success. Unfortunately, randomized clinical trials are very rare or nonexistent. In the future, new and theoretically promising therapy options, such as imatinib and OPG/AMG 162, will be available for these patients.
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Affiliation(s)
- Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center and Academic Center for Dentistry (ACTA), University of Amsterdam, Amsterdam, The Netherlands.
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Vered M, Shohat I, Buchner A, Dayan D, Taicher S. Calcitonin nasal spray for treatment of central giant cell granuloma: Clinical, radiological, and histological findings and immunohistochemical expression of calcitonin and glucocorticoid receptors. ACTA ACUST UNITED AC 2007; 104:226-39. [PMID: 17630098 DOI: 10.1016/j.tripleo.2006.05.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 03/30/2006] [Accepted: 05/04/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To provide clinical, radiological, and histopathologic analyses of 5 patients with central giant cell granuloma (CGCG) treated with calcitonin nasal spray; to compare the results to 11 well-documented cases in the literature; and to evaluate lesions for immunohistochemical expression of calcitonin receptors (CTR) and glucocorticoid receptors (GCR). STUDY DESIGN Five patients with CGCG were treated with calcitonin nasal spray, 200 to 400 IU/day, for 13 to 64 months. CTR and GCR expression were examined at different treatment times. RESULTS No lesions showed significant clinical and/or radiological improvement in size. The main benefit was thickening of the cortical plates. All patients eventually underwent curettage and continued calcitonin treatment. Significant radiological improvement was noticed 2 to 4 months postsurgical procedure. Each lesion exhibited a different immunoprofile for CTR and GCR, pretreatment and during treatment. CTR disappeared after long-term calcitonin treatment. GCR exhibited variable changes. CONCLUSION Long-term nasal spray calcitonin was ineffective for CGCG management compared with calcitonin injections. It is suggested that lesions with an undesirable response should be evaluated for CTR and GCR expression at different treatment times for maximal benefit of calcitonin treatment.
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Affiliation(s)
- Marilena Vered
- Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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35
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Xia J, Li C, Hong Y, Yang L, Huang Y, Cheng B. Short-term clinical evaluation of intralesional triamcinolone acetonide injection for ulcerative oral lichen planus. J Oral Pathol Med 2006; 35:327-31. [PMID: 16762012 DOI: 10.1111/j.1600-0714.2006.00441.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Efforts are made in a continued searching for novel therapies for symptomatic oral lichen planus (OLP). This study aimed to evaluate the efficacy and safety of intralesional triamcinolone acetonide (TA) injection for ulcerative OLP. METHODS Forty-five patients with clinical and histologically confirmed ulcerative OLP on bilateral buccal mucosa, one for treatment and the other for control, were studied. All participants received 0.5 ml TA (40 mg/ml) on experimental sites. Visual analogue scale score and lesion areas were recorded at the time of injection and 1-week interval. After 2 weeks, if the treated ulceration reduced < 81% in size, a second injection was given. RESULTS The treated group gave rapid relief of signs and symptoms, while the control group showed minimal decrease. 38 (84.4%) patients demonstrated complete response in ulceration size. No complications were noted with TA injections. CONCLUSIONS Intralesional TA injection in ulcerative OLP is effective and safe in achieving lesion and pain regression.
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Affiliation(s)
- Juan Xia
- Department of Oral Medicine, Guanghua School of Stomatology, Sun Yat-sen University, No. 56 Lingyuanxi Road, Guangzhou, Guangdong 510 055, China
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36
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Farrier SL, Farrier JN, Smart MK, Nash ES. A 10-year review of the occurrence and treatment of central giant cell granulomas, in a District General Hospital. J Oral Pathol Med 2006; 35:332-7. [PMID: 16762013 DOI: 10.1111/j.1600-0714.2006.00384.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is considerable variation in the clinical presentation, behaviour and radiological appearance of central giant cell granulomas (CGCGs), for which multiple treatment modalities have been suggested. METHOD A 10-year retrospective review of the clinical presentation, radiological features and treatment received was undertaken. RESULTS The cohort of patients included six males and three females, with an age range of 7-61 years. Six lesions were in the mandible and three in the maxilla. Eight lesions presented with swelling, three in relation to teeth. One case was an incidental finding. Six cases were confined within the cortical plates, one involved soft tissue. Radiological presentation was diverse, but within the existing confines of CGCGs. With one exception, primary treatment was surgical resection with excisional curettage of the remaining bone; to date, none have recurred. CONCLUSION Diagnosis relies on correct interpretation of clinical, radiographical and histopathological data. Alternative treatments are worthy of consideration, although surgical excision remains the treatment of choice.
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Affiliation(s)
- S L Farrier
- Adult Dental Health, University of Wales Dental Hospital, Cardiff, Wales, UK.
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37
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Kruse-Lösler B, Diallo R, Gaertner C, Mischke KL, Joos U, Kleinheinz J. Central giant cell granuloma of the jaws: A clinical, radiologic, and histopathologic study of 26 cases. ACTA ACUST UNITED AC 2006; 101:346-54. [PMID: 16504869 DOI: 10.1016/j.tripleo.2005.02.060] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Revised: 02/09/2005] [Accepted: 02/10/2005] [Indexed: 01/10/2023]
Abstract
The clinical behavior of central giant cell granuloma (CGCG) of the jaws is variable and difficult to predict. Clinical data and follow-up information of 26 patients with CGCG were analyzed. Histologic features were correlated with the clinical course of the disease. In 16 patients the CGCGs were asymptomatic; 10 lesions presented with aggressive growth, pain, massive swelling, root resorption, cortical perforation, and/or recurrence. These patients were younger and the lesions were larger than in the nonaggressive group. The histomorphometric analysis proved a significant increase in large giant cells, fractional surface area, and mitotic activity in aggressive CGCG lesions. Immunohistologic investigation (Ki-67 and p53 stain) revealed no significant differences. After surgical treatment, 3 patients with aggressive lesions developed a recurrence. The data show that clinical and histomorphometric features may be reliable indicators for the differentiation between aggressive and nonaggressive CGCG. This should be accounted for to improve the individual planning of the treatment and follow-up.
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Affiliation(s)
- Birgit Kruse-Lösler
- Department of Craniomaxillofacial Surgery, University of Münster, Münster, Germany.
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38
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Edwards PC, Fox J, Fantasia JE, Goldberg J, Kelsch RD. Bilateral central giant cell granulomas of the mandible in an 8-year-old girl with Noonan syndrome (Noonan-like/multiple giant cell lesion syndrome). ACTA ACUST UNITED AC 2005; 99:334-40. [PMID: 15716842 DOI: 10.1016/j.tripleo.2004.08.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We report a case of an 8-year-old girl who presented with bilateral central giant cell granulomas of the posterior mandible. Characteristic facial features and a history of pulmonary stenosis led us to suspect a diagnosis of Noonan syndrome. A medical geneticist confirmed this. This case report will discuss the salient features of this diagnosis.
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Affiliation(s)
- Paul C Edwards
- Department of General Dentistry, Creighton University School of Dentistry, Omaha, NE 68178, USA.
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39
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Abdo EN, Alves LCF, Rodrigues AS, Mesquita RA, Gomez RS. Treatment of a central giant cell granuloma with intralesional corticosteroid. Br J Oral Maxillofac Surg 2005; 43:74-6. [PMID: 15620781 DOI: 10.1016/j.bjoms.2004.08.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2004] [Indexed: 12/21/2022]
Abstract
A recurrent central giant cell granuloma in a 14-year-old girl in the anterior region of the mandible was treated successfully by intralesional injection of corticosteroid.
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Affiliation(s)
- Evandro Neves Abdo
- Department of Oral Surgery and Pathology, Faculty of Odontologia, School of Dentistry, Federal University of Minas Gerais, Av.: Antônio Carlos, 6627 sala 3204, Belo Horizonte, Minas Gerais, CEP 31270901, Brazil.
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