Extensive Aggressive Central Giant Cell Granuloma of the Mandible: Conservative Steroids Treatment in a Pediatric Patient

Central giant cell granuloma (CGCG) is described by the World Health Organization (WHO) as a localized and benign but sometimes aggressive lesion characterized by an osteolytic proliferation consisting of fibrous tissue with hemorrhage and hemosiderin deposits, the presence of osteoclastlike giant cells and reactive bone formation.1 Its etiology is unknown. Clinically, CGCG patients may present with swelling, pain, rapid growth, cortical perforation, tooth mobility or displacement, and root resorption.2 Radiologically it presents as a clearly delineated, radiolucent area that is either unior multiloculated with rare root resorption and cortical perforation.3 In 1986, Chuong et al differentiated aggressive and nonaggressive lesions on clinical and radiological findings. Nonaggressive lesions are asymptomatic, slowly evolving, and do not erode the cortical bone or root. Aggressive lesions occur in younger patients, present pain, paresthesia, large size (greater than 5 cm), root resorption, cortical perforation, and rapid growth with tendency to recur.4 Multiple treatments are described in the literature. The most common is surgery (curettage, resection) with a range of recurrence rates of 11 to 49%.5 Other treatments have included radiotherapy, even if sporadically reported, systemic injection of calcitonin or by inhalation administration, corticosteroid intralesional injection, and interferon α.2,6,7 The results of the different medical treatments are heterogeneous and still under discussion. The aim of this work was to present our experience in the treatment of a very extensive CGCG mandibular lesion of a tooth-bearing aesthetic area in a 9-year-old female patient. A less aggressive treatment choice was performed with corticosteroid intralesional injection and minimal surgical aesthetic refinements, spearing a wide mandibulectomy and a reconstructive fibular free flap.