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Published in: Oral and Maxillofacial Surgery 2/2016

01-06-2016 | Case Report

Management of central giant cell granuloma of the jaws with intralesional steroid injection and review of the literature

Authors: Doğan Dolanmaz, Alparslan Esen, Ahmet Mihmanlı, Kubilay Işık

Published in: Oral and Maxillofacial Surgery | Issue 2/2016

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Abstract

Purpose

We report the results of the intralesional steroid injections for the management of central giant cell granuloma (CGCG) of the jaws.

Methods

Seven CGCGs were treated with intralesional injection of corticosteroids. To accomplish this, 3.5 mL of triamcinolone and 3.5 mL of 0.5 % marcaine with 1/200,000 epinephrine (total 7 mL) were mixed. An adequate amount of steroid was injected into different areas of the lesion. This procedure was repeated on a weekly basis for 6 weeks.

Results

Clinical and radiological examination showed complete resolution and ossification of the lesions in four patients. Partial recovery was achieved in two patients. One patient did not respond to the treatment and underwent surgical curettage.

Conclusions

We suggest that intralesional steroid injection is safe and effective for the treatment of CGCG, especially in non-aggressive lesions.
Literature
1.
go back to reference Jaffe HL (1953) Giant-cell reparative granuloma, traumatic bone cyst, and fibrous (fibro-oseous) dysplasia of the jawbones. Oral Surg Oral Med Oral Pathol 6:159–175CrossRefPubMed Jaffe HL (1953) Giant-cell reparative granuloma, traumatic bone cyst, and fibrous (fibro-oseous) dysplasia of the jawbones. Oral Surg Oral Med Oral Pathol 6:159–175CrossRefPubMed
2.
go back to reference Motamedi MH, Eshghyar N, Jafari SM, et al. (2007) Peripheral and central giant cell granulomas of the jaws: a demographic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103:e39–e43CrossRefPubMed Motamedi MH, Eshghyar N, Jafari SM, et al. (2007) Peripheral and central giant cell granulomas of the jaws: a demographic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103:e39–e43CrossRefPubMed
3.
go back to reference Kaffe I, Ardekian L, Taicher S, Littner MM, Buchner A (1996) Radiologic features of central giant cell granuloma of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 81:720–726CrossRefPubMed Kaffe I, Ardekian L, Taicher S, Littner MM, Buchner A (1996) Radiologic features of central giant cell granuloma of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 81:720–726CrossRefPubMed
4.
go back to reference de Lange J, van den Akker HP, van den Berg H (2007) Central giant cell granuloma of the jaw: a review of the literature with emphasis on therapy options. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:603–615CrossRefPubMed de Lange J, van den Akker HP, van den Berg H (2007) Central giant cell granuloma of the jaw: a review of the literature with emphasis on therapy options. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:603–615CrossRefPubMed
5.
go back to reference Regezi JA, Sciubba JJ, Jordan RCK (2012) Oral pathology: clinical pathologic correlations. Elsevier Sounders, St.Louis, Missouri Regezi JA, Sciubba JJ, Jordan RCK (2012) Oral pathology: clinical pathologic correlations. Elsevier Sounders, St.Louis, Missouri
6.
go back to reference Chuong R, Kaban LB, Kozakewich H, Perez-Atayde A (1986) Central giant cell lesions of the jaws: a clinicopathologic study. J Oral Maxillofac Surg 44:708–713CrossRefPubMed Chuong R, Kaban LB, Kozakewich H, Perez-Atayde A (1986) Central giant cell lesions of the jaws: a clinicopathologic study. J Oral Maxillofac Surg 44:708–713CrossRefPubMed
7.
go back to reference Shirani G, Abbasi AJ, Mohebbi SZ, Shirinbak I (2011) Management of a locally invasive central giant cell granuloma (CGCG) of mandible: report of an extraordinary large case. J Craniomaxillofac Surg 39:530–533CrossRefPubMed Shirani G, Abbasi AJ, Mohebbi SZ, Shirinbak I (2011) Management of a locally invasive central giant cell granuloma (CGCG) of mandible: report of an extraordinary large case. J Craniomaxillofac Surg 39:530–533CrossRefPubMed
8.
go back to reference Whitaker SB, Waldron CA (1993) Central giant cell lesions of the jaws. A clinical, radiologic, and histopathologic study. Oral Surg Oral Med Oral Pathol 75:199–208CrossRefPubMed Whitaker SB, Waldron CA (1993) Central giant cell lesions of the jaws. A clinical, radiologic, and histopathologic study. Oral Surg Oral Med Oral Pathol 75:199–208CrossRefPubMed
9.
go back to reference Harris M (1993) Central giant cell granulomas of the jaws regress with calcitonin therapy. Br J Oral Maxillofac Surg 31:89–94CrossRefPubMed Harris M (1993) Central giant cell granulomas of the jaws regress with calcitonin therapy. Br J Oral Maxillofac Surg 31:89–94CrossRefPubMed
10.
go back to reference Flanagan AM, Nui B, Tinkler SM, Horton MA, Williams DM, Chambers TJ (1988) The multinucleate cells in giant cell granulomas of the jaw are osteoclasts. Cancer 62:1139–1145CrossRefPubMed Flanagan AM, Nui B, Tinkler SM, Horton MA, Williams DM, Chambers TJ (1988) The multinucleate cells in giant cell granulomas of the jaw are osteoclasts. Cancer 62:1139–1145CrossRefPubMed
11.
go back to reference de Lange J, van den Akker HP, van den Berg H, Richel DJ, Gortzak RA (2006) Limited regression of central giant cell granuloma by interferon alpha after failed calcitonin therapy: a report of 2 cases. Int J Oral Maxillofac Surg 35:865–869CrossRefPubMed de Lange J, van den Akker HP, van den Berg H, Richel DJ, Gortzak RA (2006) Limited regression of central giant cell granuloma by interferon alpha after failed calcitonin therapy: a report of 2 cases. Int J Oral Maxillofac Surg 35:865–869CrossRefPubMed
12.
go back to reference Bekker PJ, Holloway DL, Rasmussen AS, et al. (2004) A single-dose placebo-controlled study of AMG 162, a fully human monoclonal antibody to RANKL, in postmenopausal women. J Bone Miner Res 19:1059–1066CrossRefPubMed Bekker PJ, Holloway DL, Rasmussen AS, et al. (2004) A single-dose placebo-controlled study of AMG 162, a fully human monoclonal antibody to RANKL, in postmenopausal women. J Bone Miner Res 19:1059–1066CrossRefPubMed
13.
go back to reference Fausel C (2007) Targeted chronic myeloid leukemia therapy: seeking a cure. J Manag Care Pharm 13:8–12PubMed Fausel C (2007) Targeted chronic myeloid leukemia therapy: seeking a cure. J Manag Care Pharm 13:8–12PubMed
14.
go back to reference De Giorgi U, Verweij J (2005) Imatinib and gastrointestinal stromal tumors: where do we go from here? Mol Cancer Ther 4:495–501PubMed De Giorgi U, Verweij J (2005) Imatinib and gastrointestinal stromal tumors: where do we go from here? Mol Cancer Ther 4:495–501PubMed
15.
go back to reference Dewar AL, Farrugia AN, Condina MR, et al. (2006) Imatinib as a potential antiresorptive therapy for bone disease. Blood 107:4334–4337CrossRefPubMed Dewar AL, Farrugia AN, Condina MR, et al. (2006) Imatinib as a potential antiresorptive therapy for bone disease. Blood 107:4334–4337CrossRefPubMed
16.
go back to reference Jacoway J, Howell F, Terry B (1988) Central giant cell granuloma—an alternative to surgical therapy [abstract]. Oral Surg Oral Med Oral Pathol 66:572 Jacoway J, Howell F, Terry B (1988) Central giant cell granuloma—an alternative to surgical therapy [abstract]. Oral Surg Oral Med Oral Pathol 66:572
17.
go back to reference Terry B, Jacoway J (1994) Management of central giant cell lesions: an alternative to surgical therapy. Oral Maxillofac Surg Clin N Am 6:579–601 Terry B, Jacoway J (1994) Management of central giant cell lesions: an alternative to surgical therapy. Oral Maxillofac Surg Clin N Am 6:579–601
18.
go back to reference Carlos R, Sedano HO (2002) Intralesional corticosteroids as an alternative treatment for central giant cell granuloma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93:161–166CrossRefPubMed Carlos R, Sedano HO (2002) Intralesional corticosteroids as an alternative treatment for central giant cell granuloma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93:161–166CrossRefPubMed
19.
go back to reference Tosco P, Tanteri G, Iaquinta C, et al. (2009) Surgical treatment and reconstruction for central giant cell granuloma of the jaws: a review of 18 cases. J Oral Maxillofac Surg 37:380–387 Tosco P, Tanteri G, Iaquinta C, et al. (2009) Surgical treatment and reconstruction for central giant cell granuloma of the jaws: a review of 18 cases. J Oral Maxillofac Surg 37:380–387
20.
go back to reference Nogueira RL, Teixeira RC, Cavalcante RB, Ribeiro RA, Rabenhosrt SH (2010) Intralesional injection of triamcinolone hexacetonide as an alternative treatment for central giant-cell granuloma in 21 cases. Int J Oral Maxillofac Surg 39:1204–1210CrossRefPubMed Nogueira RL, Teixeira RC, Cavalcante RB, Ribeiro RA, Rabenhosrt SH (2010) Intralesional injection of triamcinolone hexacetonide as an alternative treatment for central giant-cell granuloma in 21 cases. Int J Oral Maxillofac Surg 39:1204–1210CrossRefPubMed
21.
go back to reference de Lange J, van Rijn RR, van den Berg H, van den Akker HP (2009) Regression of central giant cell granuloma by a combination of imatinib and interferon: a case report. Br J Oral Maxillofac Surg 47:59–61CrossRefPubMed de Lange J, van Rijn RR, van den Berg H, van den Akker HP (2009) Regression of central giant cell granuloma by a combination of imatinib and interferon: a case report. Br J Oral Maxillofac Surg 47:59–61CrossRefPubMed
22.
go back to reference Sun LM, Lin MC, Muo CH, Liang JA, Kao CH (2014) Calcitonin nasal spray and increased cancer risk: a population-based nested case-control study. J Clin Endocrinol Metab 99:4259–4264CrossRefPubMed Sun LM, Lin MC, Muo CH, Liang JA, Kao CH (2014) Calcitonin nasal spray and increased cancer risk: a population-based nested case-control study. J Clin Endocrinol Metab 99:4259–4264CrossRefPubMed
23.
go back to reference In brief (2013) cancer risk with salmon calcitonin. Med Lett Drugs Ther 55:29 In brief (2013) cancer risk with salmon calcitonin. Med Lett Drugs Ther 55:29
24.
go back to reference Kermer C, Millesi W, Watzke IM (1994) Local injection of corticosteroids for central giant cell granuloma. A case report. Int J Oral Maxillofac Surg 23:366–368CrossRefPubMed Kermer C, Millesi W, Watzke IM (1994) Local injection of corticosteroids for central giant cell granuloma. A case report. Int J Oral Maxillofac Surg 23:366–368CrossRefPubMed
25.
go back to reference Rajeevan NS, Soumithran CS (1998) Intralesional corticosteroid injection for central giant cell granuloma. A case report. Int J Oral Maxillofac Surg 27:303–304CrossRefPubMed Rajeevan NS, Soumithran CS (1998) Intralesional corticosteroid injection for central giant cell granuloma. A case report. Int J Oral Maxillofac Surg 27:303–304CrossRefPubMed
26.
go back to reference Khafif A, Krempl G, Medina JE (2000) Treatment of giant cell granuloma of the maxilla with intralesional injection of steroids. Head Neck 22:822–825CrossRefPubMed Khafif A, Krempl G, Medina JE (2000) Treatment of giant cell granuloma of the maxilla with intralesional injection of steroids. Head Neck 22:822–825CrossRefPubMed
27.
go back to reference Kurtz M, Mesa M, Alberto P (2001) Treatment of a central giant cell lesion of the mandible with intralesional glucocorticosteroids. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91:636–637CrossRefPubMed Kurtz M, Mesa M, Alberto P (2001) Treatment of a central giant cell lesion of the mandible with intralesional glucocorticosteroids. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91:636–637CrossRefPubMed
28.
go back to reference Adornato MC, Paticoff KA (2001) Intralesional corticosteroid injection for treatment of central giant-cell granuloma. J Am Dent Assoc 132:186–190CrossRefPubMed Adornato MC, Paticoff KA (2001) Intralesional corticosteroid injection for treatment of central giant-cell granuloma. J Am Dent Assoc 132:186–190CrossRefPubMed
29.
go back to reference Abdo EN, Alves LC, Rodrigues AS, Mesquita RA, Gomez RS (2005) Treatment of a central giant cell granuloma with intralesional corticosteroid. Br J Oral Maxillofac Surg 43:74–76CrossRefPubMed Abdo EN, Alves LC, Rodrigues AS, Mesquita RA, Gomez RS (2005) Treatment of a central giant cell granuloma with intralesional corticosteroid. Br J Oral Maxillofac Surg 43:74–76CrossRefPubMed
30.
go back to reference Sezer B, Koyuncu B, Gomel M, Gunbay T (2005) Intralesional corticosteroid injection for central giant cell granuloma: a case report and review of the literature. Turk J Pediatr 47:75–81PubMed Sezer B, Koyuncu B, Gomel M, Gunbay T (2005) Intralesional corticosteroid injection for central giant cell granuloma: a case report and review of the literature. Turk J Pediatr 47:75–81PubMed
31.
go back to reference Comert E, Turanli M, Ulu S (2006) Oral and intralesional steroid therapy in giant cell granuloma. Acta Otolaryngol 126:664–666CrossRefPubMed Comert E, Turanli M, Ulu S (2006) Oral and intralesional steroid therapy in giant cell granuloma. Acta Otolaryngol 126:664–666CrossRefPubMed
32.
go back to reference Wendt FP, Torriani MA, Gomes AP, de Araujo LM, Torriani DD (2009) Intralesional corticosteroid injection for central giant cell granuloma: an alternative treatment for children. J Dent Child (Chic) 76:229–232 Wendt FP, Torriani MA, Gomes AP, de Araujo LM, Torriani DD (2009) Intralesional corticosteroid injection for central giant cell granuloma: an alternative treatment for children. J Dent Child (Chic) 76:229–232
33.
go back to reference Mohanty S, Jhamb A (2009) Central giant cell lesion of mandible managed by intralesional triamcinolone injections. A report of two cases and literature review. Med Oral Patol Oral Cir Bucal 14:E98–102PubMed Mohanty S, Jhamb A (2009) Central giant cell lesion of mandible managed by intralesional triamcinolone injections. A report of two cases and literature review. Med Oral Patol Oral Cir Bucal 14:E98–102PubMed
34.
go back to reference Ferretti C, Muthray E (2011) Management of central giant cell granuloma of mandible using intralesional corticosteroids: case report and review of literature. J Oral Maxillofac Surg 69:2824–2829CrossRefPubMed Ferretti C, Muthray E (2011) Management of central giant cell granuloma of mandible using intralesional corticosteroids: case report and review of literature. J Oral Maxillofac Surg 69:2824–2829CrossRefPubMed
35.
go back to reference Rachmiel A, Emodi O, Sabo E, Aizenbud D, Peled M (2012) Combined treatment of aggressive central giant cell granuloma in the lower jaw. J Craniomaxillofac Surg 40:292–297CrossRefPubMed Rachmiel A, Emodi O, Sabo E, Aizenbud D, Peled M (2012) Combined treatment of aggressive central giant cell granuloma in the lower jaw. J Craniomaxillofac Surg 40:292–297CrossRefPubMed
36.
go back to reference da Silva NG, Carreira AS, Pedreira EN, Tuji FM, Ortega KL, de Jesus Viana Pinheiro J (2012) Treatment of central giant cell lesions using bisphosphonates with intralesional corticosteroid injections. Head Face Med 8:23CrossRefPubMed da Silva NG, Carreira AS, Pedreira EN, Tuji FM, Ortega KL, de Jesus Viana Pinheiro J (2012) Treatment of central giant cell lesions using bisphosphonates with intralesional corticosteroid injections. Head Face Med 8:23CrossRefPubMed
37.
go back to reference Choi JW, Kraut RA (2013) Management of central giant granuloma of mandible with intralesional triamcinolone injections: a case report. N Y State Dent J 79:34–36PubMed Choi JW, Kraut RA (2013) Management of central giant granuloma of mandible with intralesional triamcinolone injections: a case report. N Y State Dent J 79:34–36PubMed
38.
go back to reference Fonseca FP, Ribeiro AC, Santos-Silva AR, Vargas PA, Lopes MA (2013) Fine needle aspiration cytology and intralesional steroid injection in a central giant cell granuloma affecting the gingiva: a new clinical approach. Braz Dent J 24:420–427CrossRefPubMed Fonseca FP, Ribeiro AC, Santos-Silva AR, Vargas PA, Lopes MA (2013) Fine needle aspiration cytology and intralesional steroid injection in a central giant cell granuloma affecting the gingiva: a new clinical approach. Braz Dent J 24:420–427CrossRefPubMed
39.
go back to reference Marx RE, Stern D (2012) Oral and maxillofacial pathology: a rationale for diagnosis and treatment. Quintessence Publishing Company, Hanover Park Marx RE, Stern D (2012) Oral and maxillofacial pathology: a rationale for diagnosis and treatment. Quintessence Publishing Company, Hanover Park
40.
go back to reference Kremer M, Judd J, Rifkin B, Auszmann J, Oursler MJ (1995) Estrogen modulation of osteoclast lysosomal enzyme secretion. J Cell Biochem 57:271–279CrossRefPubMed Kremer M, Judd J, Rifkin B, Auszmann J, Oursler MJ (1995) Estrogen modulation of osteoclast lysosomal enzyme secretion. J Cell Biochem 57:271–279CrossRefPubMed
41.
go back to reference Kameda T, Mano H, Yuasa T, et al. (1997) Estrogen inhibits bone resorption by directly inducing apoptosis of the bone-resorbing osteoclasts. J Exp Med 186:489–495CrossRefPubMedPubMedCentral Kameda T, Mano H, Yuasa T, et al. (1997) Estrogen inhibits bone resorption by directly inducing apoptosis of the bone-resorbing osteoclasts. J Exp Med 186:489–495CrossRefPubMedPubMedCentral
42.
go back to reference Hirayama T, Sabokbar A, Athanasou NA (2002) Effect of corticosteroids on human osteoclast formation and activity. J Endocrinol 175:155–163CrossRefPubMed Hirayama T, Sabokbar A, Athanasou NA (2002) Effect of corticosteroids on human osteoclast formation and activity. J Endocrinol 175:155–163CrossRefPubMed
Metadata
Title
Management of central giant cell granuloma of the jaws with intralesional steroid injection and review of the literature
Authors
Doğan Dolanmaz
Alparslan Esen
Ahmet Mihmanlı
Kubilay Işık
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
Oral and Maxillofacial Surgery / Issue 2/2016
Print ISSN: 1865-1550
Electronic ISSN: 1865-1569
DOI
https://doi.org/10.1007/s10006-015-0530-5

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