Surgical oncology and reconstruction
Surgical Treatment, Oral Rehabilitation, and Orthognathic Surgery After Failure of Pharmacologic Treatment of Central Giant Cell Lesion: A Case Report

https://doi.org/10.1016/j.joms.2016.08.038Get rights and content

Although pharmacologic treatments for central giant cell lesions have gained much emphasis, these treatment modalities do not always have successful outcomes, and surgical treatment may be necessary. The purpose of the present study was to report a case of aggressive central giant cell lesion initially treated by nonsurgical methods without satisfactory results, necessitating segmental mandibular resection for definitive treatment and oral rehabilitation. A 20-year-old woman was diagnosed with an aggressive central giant cell lesion in the mandible. The patient was first treated with intralesional corticosteroid injections. Subsequently, the lesion increased in size. Therefore, a second pharmacologic treatment was proposed with salmon calcitonin nasal spray, but no signs of a treatment response were noted. Because of the lack of response, surgical excision was performed, and a mandibular reconstruction plate was installed. At 12 months after surgical resection, the patient underwent mandibular reconstruction with bone grafts. After 6 months, 7 dental implants were installed, and fixed prostheses were made. After installation of the prostheses, the patient experienced persistent mandibular laterognathism, and a mandibular orthognathic surgery was performed to correct the laterognathia. The follow-up examination 4 years after orthognathic surgery showed no signs of recurrence and good facial symmetry.

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Case Report

In July 2003, a 20-year-old female patient presented to the oral and maxillofacial surgery department with complaints of painful swelling in the mandible with rapid growth. Her medical and family histories were noncontributory. The extraoral clinical examination revealed considerable swelling in the region of the symphysis and left mandibular body. No associated lymphadenopathy was present. The intraoral clinical examination revealed an obliteration of the buccal sulcus, elevation of the floor

Discussion

Nonsurgical methods for the treatment of CGCL are of great importance, mainly because the prevalence of this lesion is greater in young people and the treatment can alter the development of the jaws and cause important aesthetic disfigurations. These treatments can achieve complete resolution of the lesion; however, in some cases, a bone defect can persist, requiring bone osteoplasty. In cases of partial resolution of the lesion, surgical curettage is usually used as the additional treatment.5

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