EC Dental Science

Background: Giant cell granulomas are benign osteolytic lesions of the jaws and are believed to be related to teeth. This study explores both surgical and adjunctive pharmacological therapy used in treatment of giant cell granulomas and presents the treatment options of giant cell granulomas of the jaws treated at The Leeds Teaching Hospitals NHS Trust.

Methodology: Our study was a retrospective cohort study. Eligibility criteria was a histologically confirmed giant cell granulomas (peripheral and central giant cell granulomas) with patient treated at The Leeds Teaching Hospitals NHS Trust from 2005-2017. Data collection was from the computerized hospital database. Surgery was carried out as the first line of treatment and in cases of recurrence further enucleation and curettage with pharmacological therapy. Pharmacological agents used as treatment of giant cell granulomas were intralesional steroids and calcitonin intranasal spray in two cases of recurrence followed by clinico-radiological monitoring of these patients.

Results: A total of 25 cases were treated during this period. In our study, 23 patients were treated by enucleation and curettage alone while 2 patients had further surgery with adjunctive pharmacological therapy - intralesional steroids and calcitonin intranasal spray. Age of presentation varies from 7 to 76 years with a mean age of 44.8 years. Sixteen patients [64%] presented at age 40 years and over while 16 [64%] of the 25 patients were male while 9 [36%] patients were females.

Conclusion: Our result was in variance to most studies which reported a female preponderance (2:1) and patient presentation in the first three decades of life.

 Keywords: Giant Cell Granulomas; Jaws; Enucleation; Recurrence; Pharmacological Treatment

1. Schreuder WH., et al. “Pharmacological and Surgical therapy for the Central giant cell granuloma: A long-term retrospective Cohort study”. Journal of Cranio-Maxillo-Facial Surgery2 (2017): 232-243.
2. Jaffe HL. “Giant cell reparative granuloma, traumatic bone cyst, and fibrous (fibro-osseous) dysplasia of the jawbones”. Oral Surgery, Oral Medicine, and Oral Pathology1 (1953): 159-175.
3. Pogrel AM. “The diagnosis and management of giant cell lesions of the jaws”. Annals of Maxillofacial Surgery2 (2012): 102-106.
4. Barnes L., et al. “Pathology and genetics of head and neck tumours”. Kleihues P, Sobin LH, series eds. World Health Organization Classification of Tumours. Lyon, France: IARC Press (2005): 324.
5. Whitaker SB and Waldron CA. “Central giant cell lesions of the jaws”. Oral Surgery, Oral Medicine, and Oral Pathology2 (1993): 199-208.
6. Jeyaraj P. “Management of central giant cell granulomas of the jaws. An unusual case report with critical appraisal of existing literature”. Annals of Maxillofacial Surgery 1 (2019): 37-47.
7. Shadman N., et al. “Peripheral giant cell granuloma. A review of 123 cases”. Dental Research Journal (Isfahan)1 (2009): 47-50.
8. Chaparro-Avendano AV., et al. “Peripheral giant cell granuloma. A report of five cases and review of the literature”. Medicina Oral, Patologia Oral, Cirugia Bucal 1 (2005): 53-57.
9. Carvalho YR., et al. “Peripheral giant cell granuloma. An immunohisto-chemical and ultrastructural study”. Oral Diseases 1 (1995): 20-25.
10. Regezi JA and Sciubba JJ. “Giant cell lesions”. In Oral Pathology: Clinical Pathologic Correlations 5^th St. Louis, WB Saunders (2007): 112-113.
11. Kashyap N., et al. “Central Giant Cell Granuloma”. Journal of Dentistry and Oral-Maxillofacial Surgery2 (2019): 1-4.
12. Kaban LB., et al. “Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws”. Journal of Oral and Maxillofacial Surgery10 (2002): 1103-1113.
13. Whitaker SB and Waldon CA. “Central giant cell lesions of the jaws. A clinical, radiological, and histologic study”. Oral Surgery, Oral Medicine and Oral Pathology2 (1993): 199-208.
14. Chuong R., et al. “Central giant cell lesions of the jaws: A clinicopathologic study”. Journal of Oral and Maxillofacial Surgery 9 (1986): 708-713.
15. Dimitrakopoulos I., et al. “Giant-cell granuloma in the temporal bone: A case report and review of the literature”. Journal of Oral and Maxillofacial Surgery 3 (2006): 531-536.
16. Kruse-Lösler B., et al. “Central giant cell granuloma of the jaws: A clinical, radiologic, and histopathologic study of 26 cases”. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology3 (2006): 346-354.
17. Jacoway JR. “Central giant cell granuloma: an alternative to surgical therapy”. Oral Surgery, Oral Medicine, and Oral Pathology 66 (1988): 572.
18. Pogrel MA. “Calcitonin therapy for central giant cell granuloma”. Journal of Oral and Maxillofacial Surgery 6 (2003): 649-653.
19. Harris M. “Central giant cell granulomas of the jaws regress with calcitonin therapy”. British Journal of Oral and Maxillofacial Surgery 2 (1993): 89-94.
20. Vere M., et al. “Calcitonin nasal spray for treatment of Central giant cell granuloma: clinical, radiological, and histological findings and immunohistochemical expression of calcitonin and glucocorticoid receptors”. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology2 (2007): 226-239.
21. Kaban LB., et al. “Antiangiogenic therapy of a recurrent giant cell tumour of the mandible with interferon alfa-2a”. Paediatrics 6 (1999): 1145-1149.
22. Konidena A., et al. “Multicentric giant cell tumour of the mandible: a clinical rarity”. Oral Surgery 12 (2019): 38-44.
23. Summit A and Arunkumar K. “An aggressive central giant cell granuloma of mandible in an older patient managed successfully with marginal mandibulectomy and reconstruction with submental island flap”. Cereus 6 (2021): e15414.
24. Chrcanovic BR., et al. “Central giant cell lesion of the jaws: An updated analysis of 2270 cases reported in the literature”. Journal of Oral Pathology and Medicine 8 (2012): 731-739.
25. De Lange J and Van de Akker HP. “Clinical and radiological features of Central giant-cell lesions of the jaw”. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 4 (2005): 464-470.
26. Stavropoulos F and Katz J. “Central giant cell granulomas: a systematic review of radiographic characteristics with the addition of 20 new cases”. Dentomaxillofacial Radiology4 (2002): 213-217.