OMFS-0205Benign jaw lesionsPathologyadvancedAnterior mandible crossing midline

Anterior mandibular swelling crossing the midline in a young adult

21-year-old female

Draft — educational study aid, pending faculty review.

§Chief complaint

Expanding lump in the front of the lower jaw for 5 months

§Medical & dental history

01No renal disease
02No fractures, no known endocrine disorder
03Anterior teeth slightly displaced, all vital

§Clinical examination

01Firm expansile swelling from 34 to 43, crossing the midline, buccal and lingual
02Mucosa intact, mild bluish tinge over the thinnest cortex
0333-43 displaced with diastemas; all vital
04No paraesthesia

§ 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 granulomaAnterior mandible, young patient, crosses midline, multilocular

Brown tumour of hyperparathyroidismIdentical histology — requires biochemical exclusion

Aneurysmal bone cystBlow-out expansion, blood-filled spaces, fluid levels on MRI

CherubismBilateral, familial, childhood onset

§Final diagnosis

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

Histology of multinucleated giant cells in a vascular fibrous stroma with haemorrhage and haemosiderin fits both CGCG and brown tumour, so normal serum calcium, phosphate, alkaline phosphatase and parathyroid hormone are needed before the diagnosis is made.

§Investigations

01Serum calcium, phosphate, ALP and PTH — all normal, excluding hyperparathyroidism
02Incisional biopsy
03Baseline photographs and study models

§Radiology

01OPG — multilocular radiolucency crossing the midline with wispy septa and root displacement
02CBCT — buccal and lingual expansion with focal cortical perforation; root resorption of 42

§Treatment plan

01Thorough curettage with peripheral ostectomy, preserving the vital dentition
02Consider intralesional corticosteroid injections or calcitonin for aggressive residual disease
03Orthodontic realignment after healing

§Surgical procedure

01Degloving approach 35-45, bone window and complete curettage of the friable brown vascular tissue
02Peripheral ostectomy with a round bur; haemostasis with bone wax and packing

§Histopathology report

Multinucleated osteoclast-like giant cells unevenly distributed in a cellular fibrous stroma with spindle cells, extravasated red cells, haemosiderin and reactive osteoid. No atypia. Consistent with central giant cell granuloma (correlate with serum calcium and PTH).

§Follow-up & outcome

013 months — early bony infill, teeth remain vital
0212 months — substantial ossification; orthodontics begun
03Radiographic review every 6 months for 3 years given the aggressive subtype

Outcome: Lesion resolved after curettage; teeth retained and aligned, no recurrence at 3 years.

§Discussion

01Aggressive CGCG is defined by pain, rapid growth, cortical perforation, root resorption or recurrence; non-aggressive lesions are slow and incidental.
02Medical adjuncts include intralesional triamcinolone, calcitonin, interferon alpha-2a and denosumab for extensive lesions.
03Always exclude a brown tumour — treating one surgically while missing hyperparathyroidism leaves the driver untreated.

§Clinical pearls / learning points

01Giant cells on histology = check calcium and PTH before you close the case.
02Anterior mandible crossing the midline in a patient under 30 is the classic CGCG profile.

§Viva questions

How do you distinguish CGCG from a brown tumour?

Only biochemically — serum calcium, phosphate, ALP and PTH; the histology is identical.

List features of an aggressive CGCG.

Size over 5 cm, pain, rapid growth, root resorption, cortical perforation and recurrence after treatment.

§MCQs

Q1Which investigation is mandatory before diagnosing central giant cell granuloma?

Q2Cherubism is distinguished from CGCG by:

§ 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.