Giant cell granuloma (GCG) is an uncommon bony lesion in the head and neck region, most commonly affecting the maxilla and mandible and has a female predilection. The clinical behavior of central GCG ranges from a slowly growing asymptomatic swelling to an aggressive lesion. The clinical, radiological, histological features and management of an aggressive GCG of maxilla in an 18-year-old female patient are described and discussed. It is emphasized that surgery is the traditional and still the most accepted treatment for GCG. Le Fort I osteotomy has been advocated as one of the access osteotomy for the surgical management of aggressive and extensive GCG involving the maxilla. The postoperative morbidity and recurrence have been discussed.
... Root resorption and tooth displacement may also be evident. (29) Although radiographic features of CGCG are not pathognomonic. There were similar findings in the OPG view of our patient, which revealed well-defined periapical unilocular radiolucent area involving the apices 11 (FDI) and 12 (FDI) with no evidence of root resorption or tooth displacement. ...
... consistent with Reichart P and Philipsen HP 2004. (47) Although this presented case was treated with traditional surgery (curettage), clinical and radiographic follow-up was done for next two year period without recurrence of the lesion was evident, indicate complete elimination and cure of the lesion. In agreement with Ahmad et al., 2016 (48) and Reddy. 2012 (29) But inconsistent with Manchanda et al., 2011 (49) who reported that surgical curettage of well-defined localized lesions is associated with a low rate of recurrence. Finally, traditional surgery of an aggressive CGCG was performed without lesion recurrence is attributed to small lesion size, early diagnosis, and high standard surgi ...
... In agreement with Ahmad et al., 2016 (48) and Reddy. 2012 (29) But inconsistent with Manchanda et al., 2011 (49) who reported that surgical curettage of well-defined localized lesions is associated with a low rate of recurrence. Finally, traditional surgery of an aggressive CGCG was performed without lesion recurrence is attributed to small lesion size, early diagnosis, and high standard surgical curettage that is difficult in the maxillae. ...
... It is seen more frequently in females than in males, and it presents in the first 3 decades of life (1,2). It is divided into two groups as peripheral and central lesions. ...
... It is more common in females. It usually appears in the mandibula and maxilla and sometimes displays a locally aggressive course (1)(2)(3). It is histologically defined as a non-encapsulated mass, including fibroblastic fusiform cells, multinuclear giant cells, and extravasated erythrocyte clusters. ...
... The recurrence rate of incompletely excised lesions is 4%-20% (2). Calcitonin and intralesional steroid are given daily as medical treatment (1)(2)(3). ...
Giant cell reparative granuloma is a disease with an unknown etiology, characterized of benign locally aggressive lesions invading mandible and maxilla in the head and neck region. These lesions usually present as a mass and cause deformities at bony structures. The use of various medical and surgical procedures in the treatment of the disease with its rare occurrence makes these lesions interesting. In this case report we present a 47 years old female patient who had a painful swelling in the left lower left jaw and oral cavity since 8 months. After her complaints proceeded despite medical therapy, she has been operated and pathology report confirmed a giant cell reparative granuloma. We also discuss differential diagnosis and the achievements in treatment procedures.
Odontogenic keratocyst (OKC) rarely extends to the maxillary sinus and pterygoid process. However, residual or recurrent lesions occur more frequently in these sites than at other sites, and removal is often difficult. We experienced a case of recurrent OKC in the maxilla that extended to the maxillary sinus and pterygoid process and was removed via a Le Fort I osteotomy. A 59-year-old woman visited our hospital in August 2020 with the chief complaint of swelling in the posterior right maxilla. The patient had undergone a cystectomy at the age of 56 years, and a cystic lesion was found in the same area three years and two months after surgery, which was diagnosed as recurrent OKC. The lesion partially extended to the posterior sinus wall and the pterygoid process. A cystectomy was performed in September 2020 via a Le Fort I osteotomy. This approach provided a direct view of both the maxillary sinus and the pterygoid process, and the lesion could be removed. The pathological diagnosis was OKC. No recurrence was observed at two years and three months after surgery, and close follow-up is ongoing.
Objective:
To perform an integrative review associating current literature with a clinical series regarding the use of Le Fort I osteotomy for the removal of tumors located in the midface and central region of the skull base.
Methods:
A systematic review was performed through the PubMed, SCOPUS, and Cochrane databases. In addition, 4 different patients operated using the above-cited technique are described in this study.
Results:
Initially, 123 articles were found. After the removal of duplicates, and title and abstract reading, 27 articles were selected for data extraction. The Le Fort I surgical approach of tumors was performed in 183 patients.
Conclusion:
The Le Fort I surgical approach allows lesion exeresis with good visualization, low rates of recurrences and complications, and without aesthetic compromises for the patient.
O granuloma de células gigantes (GCG) é uma doença incomum, de etiologia indeterminada, comportamento variado e potencialmente destrutivo e, na face, atinge principalmente a região de mandíbula. Discute-se o melhor método para seu tratamento, buscando-se obter baixo índice de recorrência, com a menor agressão possível. A ostectomia periférica complementar à ressecção das lesões pode diminuir o índice de recorrência e, ao mesmo tempo, minimizar a morbidade associada. A cirurgia videoassistida permite exploração acurada do campo operatório em área de difícil acesso e remoção completa de lesões. Preconizamos a utilização da ostectomia periférica em cirurgia videoassistida descrita em dois casos de GCG de maxila e mandíbula.
The objective of this study was to report and evaluate our experience in the surgical treatment of mandibular central giant cell granuloma by resection without continuity defect and peripheral ostectomy.
A retrospective analysis was conducted of patients with central giant cell granuloma of the mandible who were treated between 1991 and 2000, in the Oral and Maxillofacial Surgery Unit at Jordan University of Science and Technology. A uniform surgical technique was used in all cases. The compact bone composed of the lower border of the mandible and/or posterior border of the ascending ramus, together with the nutrient periosteum attached to it, was preserved. All soft tissues in contact with or overlying the lesion and a margin of cancellous bone related to the lesion were excised. All patients were reviewed annually for a follow-up period of 1 to 9 years (mean, 3.9 years).
Eighteen patients with central giant cell granuloma were included, (9 males and 9 females). Their age ranged from 10 to 46 years, with 89% younger than 40 years. Five (28%) lesions were in the incisor-canine region, 2 (11%) were confined to the premolar region, 4 (22%) were in the premolar-molar region, and 7 (39%) were in the molar-ramus region. All patients had aggressive central giant cell granulomas with pain, tooth mobility, and rapidly enlarging swelling. The initial diameter of lesions ranged from 2.7 to 10 cm. During the follow-up period, there was 1 case of recurrence, 2 (11%) patients had permanent lower lip paraesthesia, and no patient had obvious facial deformity.
Our results suggest that resection without a continuity defect and peripheral ostectomy is a satisfactory method in the treatment of central giant cell granuloma of the mandible, with no or a very low recurrence rate and favorable postoperative function.
The biologic behavior of central giant cell lesions of the jaws ranges from quiescent to aggressive with destructive expansion. To date, these variations have not been explained by the findings of routine histologic examination. This retrospective clinicopathologic study of giant cell lesions was performed to search for histologic correlates of biologic behavior. Lesions in 17 patients were classified clinically as nonaggressive (group I) or aggressive (group II). In general, group II lesions affected children at an earlier age, were larger at the time of diagnosis, and recurred more frequently. The following histologic parameters were assessed: fractional surface area occupied by giant cells (FSA), relative size index of giant cells (RSI), stromal characteristics, mitotic index, inflammatory cells, and hemosiderin content. Histologic differences between the two groups were not as clear as the differences in biologic behavior. However, aggressive lesions had a higher RSI, and recurrent giant cells lesions had a higher RSI and FSA; these parameters warrant further study. In addition, electron microscopic differences in a small number of aggressive and nonaggressive lesions were documented.
The histology, radiographs, and follow-up information for 142 cases of central giant cell lesions of the jaws were reviewed in an effort to determine which, if any, microscopic features could be correlated with clinical behavior. The majority of these lesions were asymptomatic and relatively innocuous. However, some displayed a more aggressive clinical course characterized by root resorption, pain or paresthesia, and cortical perforation. The over-all recurrence rate in the 142 cases was 16%. Adequate follow-up information (mean, 48 months) was only obtained for 47 patients, and 23 (46%) of these experienced one or more recurrences. Statistically significant histologic differences in distribution of giant cells and frequency of osteoid within the lesions were found in lesions that recurred as opposed to those that did not. The concept that giant cell lesions of the jaws are not totally different entities from giant cell tumors is discussed.
The radiologic features of central giant cell granuloma (CGCG) have not been clearly defined, and conflicting descriptions appear in the literature. This study analyzes the radiologic and clinical features of 80 cases of CGCG. In nearly 50% of the cases the lesion is located in the posterior area of the jaws, that is, the molar, ramus, and tuberosity, and not in the deciduous teeth-bearing area as was accepted in the past. Only 51% of CGCGs are multilocular, and the frequency of these lesions is significantly higher in the mandible than in the maxilla. The correlation between the lesion's size and its locularity is statistically significant, and larger lesions assume a multilocular appearance. Only 6% of the lesions crossed the midline of the jaws, a feature that was considered in the past as typical for CGCG.
The purpose of this study is to present the clinical and radiological features of 27 cases of central giant cell granuloma (CGCG) of the jaws.
This study was carried out on 27 cases diagnosed as CGCG, ranging in age from 8 to 70 years. The patient's age, sex, location of the lesion, expansion caused by the lesion, and greatest diameter were evaluated. Radiographs and radiological descriptions were studied for the features of border definition, radiopacity, locularity, root resorption, tooth displacement, and tooth association. Data were analyzed with Chi square test, Fisher's exact test, Mann Whitney U-test, and the Student t-test.
It was determined 89% of CGCG occurred prior to the age of 40. Seventy-eight percent of the cases were females. In addition, it was observed that these lesions occurred primarily in the mandible mostly anterior to the molar region. It was determined most of the lesions were multilocular. Unilocular lesions averaged 23.75 mm and multilocular lesions were 53.00 mm. In 24 (89%) cases regular borders were seen, and in three cases diffuse borders were observed. There was bone expansion in 44% of the cases. The cases with bone expansion were 60.00 mm in average size, and the cases without bone expansion were 24.00 mm in average size. Seventy-eight percent of lesions were associated with teeth, and there was tooth displacement in 43% of these lesions. The lesions with tooth displacement were 18.33 mm in average size, and the lesions without tooth displacement were 44.00 mm in average size.
It was determined there is a significant correlation between the locularity, tooth displacement, and bone expansion with the size of the CGCG.
To estimate the angiogenic activity in central giant cell granuloma (CGCG) by immunohistochemical stains for vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF). VEGF and bFGF immunoreactivity of the lesional mononuclear (MC) and giant (GC) cells was also investigated.
The study consisted of 41 cases of CGCG. Vascularity was quantified by microvascular volume (MVV) as determined by point counting. In five cases of CGCG, regions at the surrounding border, which demonstrated reactive vascular-rich inflammatory areas, served as control. Immunoreactivity of the MC and GC was assessed as the percentage of VEGF- and bFGF-positive cells from the total number of the respective cell type.
Within CGCG lesions the extent of angiogenesis was low; MVV did not exceed 5% for either VEGF (88% of lesions) or bFGF (78% of lesions). The mean MVV of VEGF- and bFGF-positive blood vessels was 2.9% +/- 2.4% and 3.46% +/- 2.35%, respectively, significantly lower than in the control areas (27.5% +/- 7.3% and 28.08% +/- 5.5%, respectively) (P = 0.043). VEGF-positive and bFGF-positive MC and GC were found in nearly all lesions and in less than half of the lesions, respectively.
The low mean MVV of VEGF- and bFGF-positive blood vessels implies low angiogenic activity, which does not support the designation of CGCG as a true proliferative vascular lesion. MC and GC immunoreactivity for the angiogenic factors is assumed to play an important role in the osteoclastogenesis process, thus contributing to additional growth of the CGCG lesions.
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Cawson's Essentials of Oral Medicine and Pathology