May 16, 2014 educational video created by unmc college of dentistry class of 2016 dental students. Formerly called giant cell reparative granuloma giant cell lesion primarily of jaw, also other craniofacial bones and short tubular bones of hands and feet may be response to injury but some cases behave aggressively giant cells have features of macrophages and osteoclasts. Calcitonin therapy for central giant cell granuloma article in journal of oral and maxillofacial surgery 616. The case reported here resembled a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examination but was. Central giant cell granuloma resistant to calcitonin nasal spray. Granulomata definition of granulomata by medical dictionary. Treatment with calcitonin, triamcinolone acetonide, and a cystic finding 3 years and 6 months after the primary treatment. A unilocular central giant cell granuloma of the right mandible treated with a sixweek course of intralesional.
Some, however, consider it to be a giant cell tumor occurring in both benign and. Peripheral giant cell granuloma pgcg is an oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma. They result from a local inflammatory process, thought to be secondary to trauma. Central giant cell granuloma cgcg is defined by the world health organization as an intraosseous lesion consisting of cellular fibrous. The diagnosis and management of giant cell lesions of the jaws ncbi. Seven cgcgs were treated with intralesional injection of corticosteroids. It was first described as central giant cell reparative granuloma by jaffe h l in the year 1953. Giantcell reparative granuloma, features of cgcg is its ability to cross the midline of the traumatic bone cyst and fibrous fibrooseous mandible. A solid swelling was observed in the area of the lower incisors. Treatment of central giant cell granuloma of the jaw with calcitonin. Giant cell granuloma description of giant cell granuloma.
Oct 19, 2015 we report the results of the intralesional steroid injections for the management of central giant cell granuloma cgcg of the jaws. Central giant cell granuloma appears references as poorly defined unilocular radiolucency or multilocular radiolucency with scalloped borders. Conventional treatment for the central giant cell granuloma cgcg has been local curettage, and this has been associated with a high success rate and a low recurrence rate. Giant cell reparative granuloma, features of cgcg is its ability to cross the midline of the traumatic bone cyst and fibrous fibrooseous mandible. The world health organization who has defined cgcg as an intraosseous nonneoplastic lesion, consisting of cellular fibrous tissues that contain multiple. Peripheral giantcell granuloma pgcg is an oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma. Giant cell lesions of the jaws were separated out from other jaw lesions by jaffe in 1953 when they were termed giant cell reparative granulomas. This is in contrast to the giant cell tumor of long bones, where the giant cells are more. Giant cell granuloma of the jaw is a benign lesion that may cause local destruction of bone and displacement of teeth. Treatment of central giant cell lesions using bisphosphonates. Central giant cell granuloma cgcg is a benign bone lesion which can be locally aggressive or may be asymptomatic in nature. The diagnosis and management of giant cell lesions of the.
Some case reports mention treatment by local injection of corticosteroids into the lesion19,23 or by radiotherapy9. Full text pimary hyperparathyroidism as central giant cell. From the radiographic exam, we observed a radiolucent image in the mandibular bone with welldefined limits extending from the apical region of tooth 33. The appearance is generally distinctive with multinucleated giant cells spread throughout the lesion but often focal in distribution around areas of possible hemorrhage figure 4. Central giant cell granuloma cgcg is a benign, proliferative, intraosseous and nonodontogenic lesion of unknown etiology. Although there is not enough evidence that this lesion promotes reparative process, it was denominated reparative giant cell granuloma2, 2530. Central giant cell lesions cgcls are benign intraosseous proliferative lesions that occur in the maxilla and mandible primarily during the first to third decades of life. Central giant cell lesions granuloma radiology reference. Aggressive central giant cell granuloma of the mandible, a. Introduction giant cell reparative granuloma was first described by jaffe in 1953. F stavropoulos and j katz central giant cell granulomas. Central giant cell lesions the central giant cell granuloma, also known as cgcl or giant cell lesion, was first described by jaffe in 1953.
An aggressive central giant cell granuloma in a pediatric. Jun 19, 2018 the peripheral giant cell granuloma has an unknown etiology, with some dispute as to whether this lesion represents a reactive or neoplastic process. Central giant cell lesions granuloma dr yuranga weerakkody and assoc prof frank gaillard et al. It usually presents as a purplishred soft tissue nodule consisting of multinucleated giant cells in a background of mononuclear stromal cells and extravasated red blood cells. The referring doctor had suggested a diagnosis of eruption cyst. Management of a locally invasive central giant cell granuloma cgcg of mandible. Central giant cell granuloma venkateshwarlu et, al 6. Giant cell granuloma is an uncommon bony lesion in the head and neck region, most commonly affecting the maxilla and mandible. Interventions for central giant cell granuloma cgcg of the jaws source. Management of central giant cell granuloma of the jaws with. A nonneoplastic inflammatory lesion, usually of the jaw or gingiva, containing large, multinucleated cells. Jun 19, 2018 this peripheral giant cell granuloma involved the maxillary gingiva associated with an erupting central incisor of a 6yearold girl. Treatment of central giant cell granulmoma of the jaw with calcitonin.
Pimary hyperparathyroidism as central giant cell granuloma of the jaws. Central giant cell granuloma cgcg is defined by the world health organization as. Full text pimary hyperparathyroidism as central giant. The concept at that time was that these lesions only seemed to occur in the jaws, they were found in the first two decades of life, more frequently in females approximately 2. Aggressive central giant cell granuloma occurring as peripheral one is a very rare case and the treatment of aggressive central giant cell granuloma with curettage has shown a high recurrence rate within a span of six months, but in our case even after one year followup, no recurrence of the lesion was noticed. Central giant cell lesions granulomas, also known as giant cell reparative cystsgranulomas, occurs almost exclusively in the mandible, although cases in the skull and maxilla have been reported. However, most authorities believe peripheral giant cell granuloma is a reactive lesion. A clinical, radiologic and histopathologic study of 26 cases ooo 2006. It is an uncommon tumor in jaws, its etiology and pathogenesis is unknown.
Salmon calcitonin a boon in the management of central giant cell. Central giant cell lesion cgcl is a benign lesion which has unpredictable biologic behaviour and is amenable to a plethora of treatment alternatives. Download citation calcitonin therapy for central giant cell granuloma a. The appearance is generally distinctive with multinucleated giant cells spread throughout the lesion but often focal in distribution around areas of possible hemorrhage. This lesion occurs most commonly in maxilla and mandible, rare cases have been reported in the bones of skull, including the orbit 3,4, paranasal sinuses, cranial vault, temporal 7,8, sphenoid and occipital bones. Giant cell granulomas are benign intraosseous lesions, typically occurring in young females. Central giant cell granuloma is a benign intraosseous lesion of the jaws. Central giant cell granuloma cgcg is a benign aggressive destructive osteolytic lesion of osteoclastic origin 1 that ocur in the mandible and maxilla and accounts for approximately 7% of all benign tumours of jaws 2. Central giant cell granuloma cgcg is a benign intraosseous lesion that occurs in long bones. Intralesional corticosteroid injection for central giant. Central giant cell granuloma in eight year old patient.
Intralesional corticosteroid injection for central giant cell. Although it is a benign disease process, it can also be locally destructive. Treatment of central giant cell granuloma of the jaw with. Recently, bisphosphonates have been used to treat central giant cell lesions. The primary treatment for a central giant cell granuloma is surgery. Also called giant cell reparative granuloma central if intraosseous. It is rare in the nasal cavity, and it might be misdiagnosed. We report a case of central giant cell granuloma of mandible in a 14yearold female patient, who is being treated solely with intranasal spray of. Pre and posttreatment pattern of clinical and radiographic presentation nalini aswath 1, pravda chidambaranathan 2. Peripheral giant cell granuloma or so called giant cell epulis is the most common oral giant cell lesion.
The diagnosis and management of giant cell lesions of the jaws. The term giant cell reparative granuloma gcrg was first used by jaffe in 1953, to distinguish these lesions from giant cell tumor of long bones. Treatment of central giant cell lesions using bisphosphonates with intralesional corticosteroid injections. These three diseases are associated because they appear frequently on gingiva. Diagnosis of central giant cell granuloma is normally made histologically from an incisional biopsy. 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 bone. May 02, 2020 the primary treatment for a central giant cell granuloma is surgery.
Divided into non and aggressive subtypes, the aggressive subtype is relatively rare and can occasionally progress rapidly, resulting in significant morbidity. Despite this, a recurrence rate of 1520% is often quoted, and in these cases treatment may need to be more aggressive and may need to consist of an en bloc resection. Later the term gcrg was changed to cgcg, deleting the word reparative owing to the destructive rather than the reparative. Management of central giant cell granuloma of the jaws. Oct 31, 2012 central giant cell granuloma is a benign condition of the jaws which may present an aggressive behavior. Giant cell reparative granuloma, central definition of. Some, however, consider it to be a giant cell tumor occurring in both benign and malignant forms, and others consider it to be a. A maxillofacial surgeon can use a specialized type of scalpel to cut out the visible mouth lesion and damaged interior jaw tissue. Alpha interferon treatment, craniofacial lesions, giant cell lesions. Central giant cell granulomas are benign tumours of the mandible, presenting in children and young adults.
We present a case of an aggressive central giant cell granuloma cgcg in a six yearold female. Aggressive central giant cell granuloma mimicking peripheral. Gcrg is an uncommon benign lesion that is most commonly found in the mandible and maxilla. Treatment of a central giant cell granuloma with intralesional corticosteroid. A 9yearold boy was complaining of swelling in the floor of the mouth. Central giant cell granuloma in anterior maxilla shwetang goswami1, haripriya2, yashwanth yadav3, ram mohan4 abstract. Casereport munzenmayer j1, tapia p2, zeballos j2, martinez a3, compan a4, urra a5, spencer ml6 summary this case report describes a 19yearold female patient with a central giant cell granuloma in the left mandibular condyle, treated with en bloc resection and reconstruction with fibula graft. It is twice as common in females and is more likely to occur before age 30.
Corticosteroids and other antiinflammatory medications are either injected or given orally to help relieve swelling and pain while the mouth heals. The mainstay of treatment of cgcl in our centre until now has been surgical curettage or resection. Educational video created by unmc college of dentistry class of 2016 dental students. Central giant cell granulomas are more common in the anterior mandible, often crossing the midline and causing painless swellings. Cgcg, as described by jaffe in 1953 is an idiopathic nonneoplastic proliferative lesion. Conventional management is surgical and consists of enucleation and curettage. This is in contrast to the giant cell tumor of long bones, where the giant cells are more evenly distributed. Frontal giant cell reparative granuloma invading orbit. Calcitonin therapy for central giant cell granuloma. Giant cell reparative granuloma gcrg is an uncommon and nonneoplastic reactive tumor that involves the maxilla and mandible in the region of the head and neck. In 1953, jaffe described it as reparative granuloma of jaw bones. Central giant cell granuloma cgcg is a localised benign condition of the jaws. Treatment of giant cell granuloma with calcitonin 373 tral giant cell granulomas are inevitably associated with loss of teeth and, in younger patients, dental germs often have to be sacrificed.
In the ninth case, the lesion resolved on calcitonin treatment only to reappear 26. Aggressive giant cell reparative granuloma of the nasal cavity. We reported a very aggressive gcrg with intracranial invasion, which was treated surgically via a combined approach of a lateral rhinotomy with a craniotomy by bilateral. We describe our experience in managing this lesion by intralesional triamcinolone. Central giant cell granuloma cgcg is a benign lesion which usually presents itself in the mandible or maxilla. The term reparative giant cell granuloma was at one time widely accepted as. We report an unusual case of giant cell reparative granuloma gcrg arising in the nasal cavity of a 7yearold girl. Peripheral giant cell granuloma refers to the gingiva giant cell epulis. Central giant cell granuloma is a benign condition of the jaws which may present an aggressive behavior. But the term reparative is obsolete, as cgcg causes the destruction of involved bones. Central giant cell granuloma, benign jaw tumor, molar, recurrent pericoronitis, multinucleated giant cells. This peripheral giant cell granuloma involved the maxillary gingiva associated with an erupting central incisor of a 6yearold girl. This lesion occurs most commonly in maxilla and mandible, rare cases have been reported in the bones of skull, including the orbit 3,4, paranasal sinuses, cranial vault, temporal 7,8, sphenoid and occipital.
The aim was to evaluate the effectiveness of the longterm administration of intranasal calcitonin spray for the treatment of central giant cell granuloma cgcg in a retrospective case study. In the ninth case, the lesion resolved on calcitonin treatment only to reappear 26 months later. Because of its overwhelming incidence on the gingiva, the condition is associated with two other diseases, pyogenic granuloma and peripheral ossifying fibroma. Histologically, multinucleated giant cells are prominent throughout the fibroblastic stroma and are often clustered around areas of haemorrhage. Central giant cell granuloma cgcg formerly called giant cell reparative granuloma is a nonneoplastic proliferative lesion of unknown etiology. Central giant cell lesions are benign intraosseous proliferative lesions that have considerable local aggressiveness. Giant cell reparative granuloma of the nasal cavity. A case of a 36yearold male with a central giant cell lesion. Dilemma in the management of central giant cell granuloma of. Due to these lesions often being symptomatic, active management is usually performed. Calcitonin therapy for central giant cell granuloma researchgate. Nonsurgical treatment methods, such as intralesional corticosteroid injections, systemic calcitonin and interferon have been reported. Central giant cell granuloma of the anterior maxilla.
We report the results of the intralesional steroid injections for the management of central giant cell granuloma cgcg of the jaws. From the radiographic exam, we observed a radiolucent image in the mandibular bone with welldefined limits extending from the apical region of. Aug 22, 2012 central giant cell lesions are benign intraosseous proliferative lesions that have considerable local aggressiveness. Central giant cell granuloma, salmon calcitonin, triamcinolone acetonide. The rationale behind injecting calcitonin in an attempt to cure a central giant cell granuloma originated with professor.
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