OMFS-0125: Expansile anterior mandibular lesion crossing the midline

§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.

§References

Neville BW et al. Oral and Maxillofacial Pathology, 5th ed.

§Related diseases

Central Giant Cell Granuloma

Benign but sometimes locally aggressive intraosseous lesion containing multinucleated giant cells.

Ameloblastoma

Benign but locally aggressive odontogenic epithelial tumour; the most common clinically significant odontogenic tumour.

Aneurysmal Bone Cyst

A rare, rapidly expanding, blood-filled, multilocular pseudocyst of bone — now recognised as a true neoplasm driven by USP6 gene rearrangements — that most commonly involves the posterior mandible of young patients.

§Similar cases

OMFS-0102

Incidental multilocular radiolucency of the mandibular ramus

OMFS-0101

Slowly enlarging swelling of the anterior maxilla

OMFS-0103

Painless mandibular expansion with tooth displacement