Long-term Clinical and Radiological Outcomes of Surgical and Pharmacological Management of Central Giant Cell Granuloma of the Jaws

Introduction: Central giant cell granuloma (CGCG) is an intraosseous benign lesion. Clinical signs and symptoms, radiological and histological features are the main criteria to differentiate between non-aggressive and aggressive lesions. Nowadays, the aggressive type is treated by resection which leads to major defects that can alter facial contour and necessitate major reconstruction. An alternative, non-surgical approach is the utilization of pharmacological agents. These alternatives are advantageous for large aggressive lesions in order to cure or reduce the size of the lesion and thus minimize/spare the surgical resection. Despite the variety of treatments available there is no consensus regarding the clinical management of these lesions, and few studies report true long-term results.

Objectives: Review and compare the long-term results of patients with CGCG of the maxillofacial skeleton treated by surgical or non-surgical intervention.

Methods: For each patient we analyzed clinical signs and symptoms, radiological and histological features, treatment preformed and lesion recurrence. Treatment success was defined as lesion regression/calcification in response to pharmacological treatment. Treatment failure was defined as lesion recurrence or un-responsiveness/progression of the lesion in response to pharmacological treatment.

Results: A retrospective study was conducted on 21 patients - 10 males and 11 females whose age ranged from 4-77 years. 23 cases of CGCG were examined in total.
77% of cases occurred before the age of 40 years. Lesions were more common in the anterior portions of the mandible, and frequently crossing the midline. In the maxilla, the left posterior region was more commonly involved. 2 cases were asymptomatic and 21 presented with pain, mobility of teeth, or mucosal expansion. Radiographically, most lesions in the maxilla were unilocular and well-defined, while in the mandible lesion were mostly multilocular and well-defined. Cortical perforation as seen in the CT scan was more abundant in the mandible. 16 cases were treated surgically by enucleation and peripheral ostectomy (7), resection (5) and thorough curettage (4). 7 cases were treated with pharmacological therapy followed by Surgery. Out of the 7 cases, 4 cases were treated with intralesional steroids and nasal calcitonin and 3 cases with intralesional steroids alone. Mean follow-up was 39.8 months (range of 3-188). Recurrence was detected in 2 cases which were treated with conservative surgery, while no cases of recurrence were identified for patients treated with resection. Furthermore, in 71% of the cases treated with pharmacological agent, calcification or regression of the lesions were observed, thus minimizing the need for extensive surgery.

Conclusion: Combination of pharmacological and surgical treatment might suggest advantage for large aggressive lesions in order to decrease or define the lesion and hence reduce the need extent of bone resection, resulting in better functional and aesthetic outcomes.