title: Central giant cell granuloma: treatment with calcitonin, triamcinolone acetonide, and a cystic finding 3 years and 6 months after the primary treatment.
abstract: BACKGROUND
  Central giant cell granuloma is a benign condition of the jaws which may present an aggressive behavior.
  
  
  METHODS
  A 9-year-old boy was complaining of swelling in the floor of the mouth. A solid swelling was observed in the area of the lower incisors. From the radiographic exam, we observed a radiolucent image in the mandibular bone with well-defined limits extending from the apical region of tooth 33 to the apical region of tooth 42.
  
  
  CONCLUSIONS
  Due to the diagnosis and the age of the patient, we chose a conservative treatment, administering subcutaneous injections of calcitonin. During this treatment, no reduction to the lesion was observed. Therefore, we chose to treat the lesion with triamcinolone acetonide. Monthly follow-ups demonstrated good lesion reduction and the absence of any clinical symptoms during the first 2 years. After a 3-year follow-up, the patient returned, presenting mobility of the lower incisors. A significant increase in the size of the lesion was observed. After a biopsy, with the removal of tissue which had the appearance of a cyst capsule, microscopic analyses were found to be compatible with a secondarily infected cyst. Two months following this procedure, the patient did not present tooth mobility anymore and the oral mucosa presented a normal aspect. Following a radiographic exam, full lesion repair was observed. These conservative treatments should be the first option in cases of central giant cell granuloma and the patient must be observed for a long period of time, until no further clinical or radiographic signs of lesions are observed.
authors.affiliation: Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil. mar_sampieri@hotmail.com
authors.forename: Marcelo Bonifácio
authors.initials: MB
authors.lastname: da Silva Sampieri
authors.forename: Renato Yassutaka Faria
authors.initials: RY
authors.lastname: Yaedú
authors.forename: Paulo Sérgio Silva
authors.initials: PS
authors.lastname: Santos
authors.forename: Eduardo Sanches
authors.initials: ES
authors.lastname: Gonçales
authors.forename: Eduardo
authors.initials: E
authors.lastname: Santa'ana
authors.forename: Alberto
authors.initials: A
authors.lastname: Consolaro
authors.forename: Lyzete Berriel
authors.initials: LB
authors.lastname: Cardoso
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001706:Biopsy; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002116:Calcitonin / Q000627:therapeutic use*; D002648:Child; D003560:Cysts / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006101:Granuloma, Giant Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D015552:Injections, Intralesional; D007279:Injections, Subcutaneous; D008297:Male; D008334:Mandible / Q000473:pathology / Q000601:surgery; D008336:Mandibular Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D009060:Mouth Floor / Q000473:pathology / Q000601:surgery; D011862:Radiography, Panoramic; D012008:Recurrence; D019233:Retreatment; D013396:Suction; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D050071:Bone Density Conservation Agents; D002116:Calcitonin; D014222:Triamcinolone Acetonide