OMFS-0125Odontogenic cystsCysts & TumoursintermediateAnterior mandible

Expansile anterior mandibular lesion crossing the midline

19-year-old female

Draft — educational study aid, pending faculty review.

§Chief complaint

Swelling of the lower front jaw noticed 6 months ago

§Medical & dental history

01No renal disease
02No history of hyperparathyroidism
03Teeth in the region vital; mild spacing noted recently

§Clinical examination

01Firm expansion of the anterior mandible crossing the midline, buccal and lingual
02Teeth 33-43 vital, mildly displaced with spacing
03Mucosa normal; no paraesthesia or pain
04No other bony lesions

§ figuresFigures (2)

Central Giant Cell Granuloma — histopath image: High magnification micrograph of a central giant cell granuloma, abbreviated CGCG. CGCGs are lesions of the mandible or maxilla. The soft tissue counterpart is peripheral giant cell granuloma. CGCG is also known as giant — Fig. 1High magnification micrograph of a central giant cell granuloma, abbreviated CGCG. CGCGs are lesions of the mandible or maxilla. The soft tissue counterpart is peripheral giant cell granuloma. CGCG is also known as giant
“Central giant cell granuloma - high mag” · Nephron · CC BY-SA 3.0 · Wikimedia Commons

Central Giant Cell Granuloma — histopath image: Intermediate magnification micrograph of a central giant cell granuloma, abbreviated CGCG. CGCGs are lesions of the mandible or maxilla. The soft tissue counterpart is peripheral giant cell granuloma. CGCG is also known — Fig. 2Intermediate magnification micrograph of a central giant cell granuloma, abbreviated CGCG. CGCGs are lesions of the mandible or maxilla. The soft tissue counterpart is peripheral giant cell granuloma. CGCG is also known
“Central giant cell granuloma - intermed mag” · Nephron · CC BY-SA 3.0 · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Central Giant Cell Granuloma figures pending faculty review.

§Differential diagnosis

Central giant cell granulomaYoung female, anterior mandible, crosses midline, wispy septa

Brown tumour of hyperparathyroidismHistologically identical — must check calcium and PTH

Aneurysmal bone cystBlood-filled spaces, rapid expansion, ballooning

AmeloblastomaOlder patient, posterior mandible, knife-edge resorption

§Final diagnosis

Central giant cell granuloma of the anterior mandible (non-aggressive type)

CGCG and brown tumour cannot be distinguished histologically — serum calcium, phosphate, alkaline phosphatase and PTH are mandatory before accepting a CGCG diagnosis. Anterior location crossing the midline in a young woman is typical of CGCG.

§Investigations

01OPG and CBCT — multilocular radiolucency with fine wispy septa crossing the midline
02Serum calcium, phosphate, ALP, PTH — all normal (excludes brown tumour)
03Incisional biopsy

§Treatment plan

01Thorough curettage with peripheral ostectomy for a non-aggressive lesion
02Intralesional corticosteroid injection or calcitonin as adjuncts or alternatives
03Resection reserved for aggressive or recurrent disease
04Preserve vital teeth where possible

§Surgical procedure

01Enucleation and curettage with peripheral ostectomy
02Vital teeth retained; apices curetted carefully

§Histopathology report

Multinucleated giant cells irregularly distributed in a cellular fibrous stroma with spindle-shaped mesenchymal cells, haemorrhage and haemosiderin deposition, with reactive osteoid. Central giant cell granuloma.

§Follow-up & outcome

01Bony infill at 12 months
02Teeth remained vital
03No recurrence at 3 years

§Clinical pearls / learning points

01Always exclude hyperparathyroidism before treating a giant cell lesion of the jaw.
02Aggressive CGCG (pain, rapid growth, root resorption, perforation) has a much higher recurrence rate.
03Medical adjuncts can reduce the extent of surgery in young patients.

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Head and Neck Tumours

5th Edition — Volume 9

WHO Classification of Tumours Editorial Board · 2022

The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

L1 · Classification — 3
L3 · Systematic review — 1
L6 · Textbook — 3

2 linked sources were published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

Open PubMed

Current Classification

Reference #1L1 · ClassificationWHO / Classification Verified

WHO Classification of Head and Neck Tumours5th Edition — Volume 9

WHO Classification of Tumours Editorial Board. IARC / World Health Organization · 2022

The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.

DOI: Identifier not availablePMID: Identifier not available

View source

Reference #2L1 · ClassificationWHO / Classification Verified

Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Odontogenic and Maxillofacial Bone Tumours

Vered M, Wright JM. Head and neck pathology · 2022 · 16(1):63-75

Summary of odontogenic and maxillofacial bone tumour changes in the 5th edition WHO classification.

DOI: 10.1007/s12105-021-01404-7PMID: 35312978

PubMed DOI Full text

Reference #3L1 · ClassificationWHO / Classification Verified

WHO Classification of Tumours Online — Head and Neck

IARC / WHO. IARC · 2022

Continuously updated online edition of the WHO head and neck tumour classification.