Surgical Management of Central Giant Cell Granuloma: Case Report

Abstract

Objective: Central giant cell granuloma(CGCG) of the jaws is a localized, benign but rarely aggressive osteolytic lesions which is characterized by multinucleated osteoclast like giant cells intermingled with oval to spindle-shaped mononuclear cells. The standard therapies are surgical curettage or resection but more recently other therapeutically options using drugs have also been performed. These drugs include corticosteroid, calcitonin, interferon, monoclonal antibody, bisphosphonates and denosumab. Case: A 13-year-old male patient was referred to clinic with complaints swelling of the anterior mandible. In clinical and radiological examinations, malocclusion, mobility, root resorption were observed in the lower incisors and cortical destruction. The result of fine needle aspiration biopsy which was performed in a private clinic was CGCG. However, an incisional biopsy was performed because the lesion was expanded aggressively. The diagnose was confirmed as CGCG. Intralesional corticosteroid injection(ILCI) was performed twice as initial therapy in 6 months, but no adequate response was observed. After each session, pubertal growth(PG) was seen firstly and looser and softer nature of mandible followed the PG process, secondly. However, radiolucency near mental foramen was regressed in the radiography, allowing us perform a safer surgery. Surgical curettage and resection of the lesion were performed and the patient was followed periodically. Conclusion: Recurrence in aggressive lesions may show different prognosis individuals in pubertal age. Although CGCG tends to shows a poor response to ILCI or surgical curettage, a combination of both treatment strategies should be considered in these aggressive cases to reduce radical surgery-related morbidities.