The Surgical Treatment of Central Giant Cell Granuloma of the Mandible
Anwar B. Bataineh, BDS, MScD, CSOS, MDSc,* Taiseer Al-Khateeb, BDS, MScD, FDSRCS(Ed), FFDRCS(Ir),† and Ma’amon A. Rawashdeh, BDS, MScD, FDSRCS(En)‡
The objective of this study was to report and evaluate our experience in the surgical treatment of mandibular central giant cellgranuloma by resection without continuity defect and peripheral ostectomy. Methods: 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 lowerborder 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). Results: Eighteen patients with centralgiant 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, toothmobility, 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. Conclusion: Our results suggest that resection without a continuity defect and peripheral osteoctomy is a satisfactory method in the treatment ofcentral giant cell granuloma of the mandible, with no or a very low recurrence rate and favorable postoperative function. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:756-761, 2002 The central giant cell granuloma (CGCG) of the jaws is a common benign lesion accounting for approximately 7% of all benign tumors of the jaws.1 The histologic features of CGCGhave been extensively discussed,2-6 and it is deﬁned by the World Health Organization as 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.7 The clinical behavior of CGCG ranges from a slowly growing asymptomatic swelling to an aggressive lesion thatmanifests with pain, local destruction of bone, root resorption, or displacement of teeth. Aggressive subtypes of CGCG have a tendency to recur after excision.5,8 CGCG usually occurs in patients younger than 30 years, is more common in females than in males, and is more common in the mandible than in the maxilla.9,10 The lesion has frequently been reported to be conﬁned to the tooth-bearing areas of thejaws2,11 and is more common in the anterior portion of the mandible, often crossing the midline.2,10 The radiologic features of the CGCG have not been clearly deﬁned, and conﬂicting descriptions appear in various textbooks and articles.9,10,12-15 The lesion may appear as a unilocular or multilocular radiolucency, with well-deﬁned or ill-deﬁned margins and varying degrees of expansion of thecortical plates. It is important to remember that the radiologic appearance 756
Received from the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. *Associate Professor. †Assistant Professor. ‡Assistant Professor. Address correspondence and reprint requests to Dr Bataineh: Jordan University of Science and...