Surgical treatment and reconstruction of central giant cell granuloma (CGCG) of the mandible of the aggressive type – case report and literature review
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Introduction: Central giant cell granuloma (CGCG) is a benign tumor-like lesion of a bone, mainly localized in the mandible. It usually occurs in children and young adults under 30 y/o., predominantly in females. The etiology of the disease remains unknown. Clinically, two types of CGCG have been distinguished – a non-aggressive one, in which the granuloma grows slowly, often asymptomatically, and aggressive type for which the following features are characteristic: increased bone destruction, severe pain, large size, rapid growth, high recurrence rate and complications such as root resorption, tooth displacement or cortical bone perforation. The treatment of CGCG depends on its type. In cases of granulomas of the aggressive type, the following therapeutic procedures have been proposed: intralesional corticosteroid injections, interferon and calcitonin therapy as well as immunotherapy with anti-bone resorptive human monoclonal antibody like denosumab. However, in most cases nonsurgical treatment is insufficient. Local curettage of the lesion also entails a high risk of relapse. Therefore, radical surgical resection, often combined with bone reconstruction, is the recommended way of treatment for aggressive CGCG. Case report: The authors present a case of a 31-year-old female patient treated for central giant cell granuloma of the mandible at the Department of Oncological and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cancer Centre and Institute of Oncology in Gliwice. The resection of CGCG localized in the mandible on the right side together with fibular free flap reconstruction has been performed, with satisfactory aesthetic effect. The immunohistochemical examination indicated a positive stain reaction for CD68 and CD31 and expression of Ki67 marker was 13%. No complications were reported in the postoperative period. The six-month follow up revealed no relapse. Conclusions: The authors claim that radical surgical management should be performed in all patients with CGCG of the aggressive type. Fibular free flap is recommended for reconstruction in large bone defects. This allows tumor-free margins at the resection and satisfactory cosmetic outcome. Quality of life and facial appearance can be improved with dental implantation after a certain period of remission. A regular follow-up is essential as an element of holistic oncological process.
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