title: Comprehensive management of an orthognathic surgery patient with aggressive central giant cell granuloma of the mandible.
abstract: This article presents a case involving a 16-year-old boy who came to the Tripler Army Medical Center Oral and Maxillofacial Surgery with a central giant cell granuloma (CGCG) on the anterior mandible. Initial management consisted of surgical curettage and intralesional injection of corticosteroids. Upon completion of steroid therapy, there was clinical and radiographic evidence of remission; however, radiographic evidence of lesion recurrence was seen at a six-month follow-up visit. The CGCG was retreated with curettage and five months of systemic injections of calcitonin, both of which failed. The lesion was most likely an aggressive form of CGCG that progressed despite conservative therapy, with destruction of hard and soft tissues, root resorption, tooth displacement, and paraesthesia in the anterior mandible. The authors present a treatment algorithm with comprehensive management involving surgical resection, reconstruction, orthodontics, and orthognathic surgery with prosthodontic considerations.
authors.affiliation: Oral and Maxillofacial Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
authors.forename: Reza J
authors.initials: RJ
authors.lastname: Sharifi
authors.forename: James J
authors.initials: JJ
authors.lastname: Closmann
authors.forename: M Anthony
authors.initials: MA
authors.lastname: Pogrel
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002116:Calcitonin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003475:Curettage; D006101:Granuloma, Giant Cell / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008336:Mandibular Diseases / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D063168:Mandibular Osteotomy / Q000379:methods*; D011859:Radiography; D019651:Plastic Surgery Procedures; D012008:Recurrence
chemical_list: D000305:Adrenal Cortex Hormones; D050071:Bone Density Conservation Agents; D002116:Calcitonin