Surgical treatment of maxillary central giant cell granuloma

Objectives: To present the surgical management of a patient with a Central giant cell granuloma (CGCG) involving the right maxilla.
Materials and methods: A clinical case is presented and discussed. A 29 years old male patient was referred because of a swelling of the right cheek since six months. A CT scan revealed a mixed radiopaque- radiolucent mass completely obliterating the right maxillary antrum with the thinning or destruction of the medial sinus wall (and involvement of the right nasal fossa) and the right orbital floor that was pushed upwards. The mass extended inferiorly into the body of maxilla up to alveolus with the involvement and erosion of the roots of right upper molars. Following an incisional biopsy, a diagnosis of CGCG was obtained. Surgery was performed under general anesthesia via a Weber Ferguson approach, in order to have a complete control of both nasal fossa and orbital floor. Postoperative course was uneventful.
Results and discussion: CGCG is an intraosseous benign but aggressive osteolytic lesion, most commonly affecting maxilla. Diagnosis of CGCG is based on imaging and histopathology. The most common presenting sign of CGCG is a painless swelling with noticeable facial asymmetry. The radiological appearance may be unilocular or multilocular radiolucency, with expansion and destruction of surrounding bone.
Conclusions: Surgery is the most frequently performed treatment option, ranging from resection to excision and curettage. Recently, intralesional corticosteroid injections, subcutaneous administration of calcitonin and the use of interferon alpha have also been suggested as possible treatment methods, with reported great success.
Clinical significance: An early diagnosis is crucial to allow a minimally invasive treatment option.

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