HighlightsCentral giant cell granuloma is considered one of the giant cell lesion affecting the oral cavity with variable histological forms; may be aggressive or non-aggressive.Many studies consider giant cell granuloma the same entity as giant cell tumor of long bones.Different treatment modalities arise due to its different histological and clinical behavior. Treatment may be medical or surgical.Intralesional injection is one of the medical lines used in management of CGCG; with high success and no side effects.In our clinical case, Cushing developed in 9 years old patient forced our team to shift toward surgical line and stop intralesional steroid injections.

Various forms of vascular lesion affect the head and neck region. The head and neck vascular lesions are classified into neoplasms and malformations. Neoplasm presents either as hemangioma or lymphangioma; neoplasm usually presents in young age compared with vascular malformation. A 9-year-old female patient presented to the outpatient clinic referred from the department of pedodontics after extraction of a right mandibular second deciduous molar. Extraction was done by dental GP in outpatient clinic. Massive bleeding followed the extraction. Bleeding was controlled by electrocoagulation of bleeding site and systemic and local application of antifibrinolytic agent. An intravenous line was placed to provide fluid replacement. Injection of intravenous cyklokapron was given to stabilize the blood clot. Selective embolization was performed 24 hours prior to surgical resection of lesion and the lesion was removed under general anesthesia followed by peripheral ostectomy of bone to remove any feeders. Different protocols are used to control life-threatening bleeding. Primary local measures such as Gelfoam packing, Tranexamic or Aminocaproic topical application, Surgicel application, Electrocautery, Bone wax, Ligation of External Carotid or Common Carotid Artery, or Selective Embolization of feeder vessel may be used to control the bleeding. Interventional radiographic blockage of feeder vessel currently shows high success rate in the management of life-threatening bleeding compared with previous techniques.

The submandibular approach has been an integral tool in facial surgery since 1934. The technique is indicated in different clinical scenarios. This approach is governed by two key determinants; namely the skin tension lines and the course of the marginal mandibular branch.Aim of study: this study suggests that moving the incision further into the neck while respecting the course of the facial nerve would help achieving both optimal esthetic outcome as well as less nerve injuries.Materials and methods: eight patients requiring facial surgery, where the submandibular approach was indicated, were recruited and the modified submandibular incision was applied. The function of the facial nerve was followed up for six months using the Houseman-Brackman test. The esthetic result was assessed by two panels; consultant maxillofacial surgeons, and lay persons mainly concerned with the esthetics. The panel reviewed the cases through a power point presentation. A questionnaire customized to each panel's expertise was then provided.Results: Surgeons grading intra-class correlation coefficient (ICC) showed that there was an excellent agreement in questions 1, 4, 5 and 7 (ICC=0.672, ICC=0.647, ICC=0.753 and ICC=0.679 respectively). The 5 different maxillofacial surgeons had excellent agreement on that the incision utilized accurately facilitated accessibility, good healing and pleasant esthetic outcome. Regarding lay persons grading, intra-class correlation coefficient (ICC) showed that there was an almost perfect inter-observer agreement on the success of the technique esthetically (ICC=0.826 and 0.838 respectively).Conclusion: the modified submandibular approach provided better aesthetic results and lower risk of facial nerve injury.

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