Management of central giant cell granulomas of the jaws: An unusual case report with critical appraisal of existing literature

Abstract

Central giant cell granuloma (CGCG) is an uncommon, benign but aggressive osteolytic neoplasm of the craniomaxillofacial region, histologically characterized by an abundance of evenly distributed multinucleated giant cells within a sea of spindle-shaped mesenchymal stromal cells, scattered throughout the fibrovascular connective tissue stroma containing areas of hemorrhage. A rapid diagnostic assessment, together with an adequate histopathologic verification, is essential to improve the management and the prognosis of this locally destructive lesion. A rare case of a large destructive CGCG involving the entire right angle of mandible, causing extensive bony resorption, and buccal, medial as well as inferior border cortical expansion with multiple perforations, in a young child is presented. It was treated successfully by enucleation and aggressive curettage followed by peripheral ostectomy preserving the continuity of the mandible. Two adjunctive measures were employed; first, chemical cauterization of the residual bony walls to prevent possible recurrence, for which this tumor is notorious, and second, placement of fresh autologous platelet-rich fibrin within the bony defect to hasten bone fill and reossification, thus obviating the need for a bone graft.

Worsening Lower Jaw Swelling and Pain in a Teenager: Differential Diagnosis and Management

“…The etiology of CGCG is unknown. The suggested theories of tumor origin include trauma, inflammatory foci, vascular mishap, or genetic predisposition [8,9]. The most common cause is post-traumatic intraosseous hemorrhage, but these are also known to occur spontaneously without any history of trauma [9].…”

Aggressive giant cell granuloma of mandible: A case report

“…Central giant cell granuloma (CGCG) is an uncommon, histologically benign but locally aggressive and destructive osteolytic lesion of osteoclastic origin that occurs in the craniofacial region, especially in jaw bones. 1 It accounts for less than 7% of all benign tumors of jaw. The lesion is commonly seen in young patients with higher female predilection.…”

Mandibular Reconstruction Following Central Giant Cell Granuloma Resection in Primary Dentition: A Case for the Use of a Costochondral Graft

“…Central giant cell granuloma (CGCG) is a benign, intraosseous lesion defined by the presence of multiple hemorrhagic foci and clusters of multinucleated, osteoclast-like giant cells within a background of fibroblastic tissues. Although they can involve all parts of the craniofacial skeleton, the mandible and maxilla are the most common locations with a relative frequency of 2:1 (Jeyaraj, 2019). Central giant cell granulomas account for roughly 7% of all benign mandibular tumors, with an incidence of about 1 in 1 million persons (Jaffe, 1953).…”

“…Central giant cell granulomas account for roughly 7% of all benign mandibular tumors, with an incidence of about 1 in 1 million persons (Jaffe, 1953). Within the mandible, the body is the most common location, with lesions often originating mesial to the first molars (Jeyaraj, 2019).…”

“…Nearly all patients with CGCG present before the age of 30, with 80% before 20; there is a slight female preponderance (60%) (Eisenbud et al, 1988; Jeyaraj, 2019; Wang et al, 2019). The most common presenting symptom is facial swelling and asymmetry, but patients may also report tooth mobility or resorption, pain, or altered sensation (de Lange et al, 2004; Sun et al, 2009).…”