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J Oral Maxillofac Surg71:721-722, 2013

Management of Central Giant Cell

Granuloma of Mandible Using Intralesional

Corticosteroids: Case Report and Review of

LiteratureSaim Yanik, DDS,*and Mutan Hamdi Aras, DDS, PhDy

We read Management of Central Giant Cell Granu-loma of Mandible Using Intralesional Corticosteroids:Case Report and Review of Literature by Ferrettiet al.1 with great interest. The paper reports a case

of managing central giant cell granuloma (CGCG)in a 16-year-old girl through the administration of in-tralesional corticosteroids. The authors state thatcomplete opacification was noted after only 2 admin-istrations of the steroid solution. They also reportthat this rapid response was unique among the casespreviously reported. However, the authors did notcompare the age of their patient and localization ofthe CGCG with previously reported cases. Even iftheir case was unique, their patient was only 16

years old and the lesion was located on the mandi-ble. We believe that younger patients experiencefaster treatment responses. Also, the localization ofthe CGCG reported in their case may be related tothe response. As is commonly known, the regenera-tion capability of the mandible is better than that ofthe maxilla.2

Because the authors did not report, in their litera-ture review, the age and gender of the patients andthe localization of the CGCGs covered, we wouldlike to add these data to clarify things for readers(Table 1).

It was thought that the age of the patient and localiza-tion of the lesion might affect the resolution of these le-sions. Carlos and Sedano3 reported in case 1 that 20injections were given within 60 weeks. In this case,

the patientwas 31 yearsold,and the lesion waslocalizedin the maxilla. In the third case, the patient was only 6

years old, and the lesion was localized in the maxillaagain; but, in this case, only 4 injections were given

within 8 weeks. In case 2, the patient was 34 yearsold, the lesion was localized in the mandible, and 17 in-

jections were given within 34 weeks. In the last case(case 4), the patient was 2 and a half years old, and thelesion was localized in the mandible again; similar tothe previous case, 4 injections were given within8 weeks. According to this information, we observedthatlesions that occurred in themandible andinyoungerpatients responded better to corticosteroid treatmentthan the others (maxilla localized and older patients).

Additionally, in 1994, Kermer et al.4 reported that10 injectionsweregiven in total. In their case, thepatient

was 40 years old, and the lesion localized in the mandi-ble. In most cases, except for those mentioned above,corticosteroid injections were given 6 times weeklyor biweekly, and in general, patients were childrenor adolescents, and lesions were localized in themandible.

Received from the Department of Oral and Maxillofacial Surgery,

Dentistry Faculty, Gaziantep University, Gaziantep, Turkey.

*Associate Professor.

yResearch Assistant.

Address correspondence and reprint requests to Dr Yanik:

Gaziantep University Dentistry Faculty Department of Oral and

Maxillofacial Surgery, Gaziantep, Turkey; e-mail: saimyanik@

hotmail.com

2013 American Association of Oral and Maxillofacial Surgeons

0278-2391/12/01502-9$36.00/0

http://dx.doi.org/10.1016/j.joms.2012.10.013

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mailto:saimyanik@hotmail.commailto:saimyanik@hotmail.comhttp://dx.doi.org/10.1016/j.joms.2012.10.013http://dx.doi.org/10.1016/j.joms.2012.10.013mailto:saimyanik@hotmail.commailto:saimyanik@hotmail.com

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References

1. Ferretti C, Muthray E: Management of central giant cellgranulomaof mandible using intralesional corticosteroids: Case report andreview of literature. J Oral Maxillofac Surg 69:2824, 2011

2. Bilezikian JP: Osteonecrosis of the jawDo bisphosphonatespose a risk? N Engl J Med 355:2278, 2006

3. Carlos R, Sedano HO: Intra-lesional corticosteroids as an alterna-tive treatment for central giant cell granuloma. Oral Surg OralMed Oral Pathol Oral Radiol Endod 93:161, 2002

4. Kermer C, Millesi W, Watzke IM: Local injection of corticoste-

roids for central giant cell granuloma: A case report. Int J OralMaxillofac Surg 23:366, 1994

5. Adornato MC, Paticoff KA: Intralesional coricosteroid injectionfor treatment of central giant-cell granuloma. J Am Dent Assoc132:186, 2001

6. Kurtz M, Mesa M, Alberto P: Treatment of a central giant celllesion of the mandible with intralesional glucocorticoste-roids. Oral Surg Oral Med Oral Pathol Oral Radiol Endod91:636, 2001

7. Terry BC, Jacoway JR: Management of central giant cell lesions:An alternative to surgical therapy. Oral Maxillofac Surg Clin NAm 6:579, 1994

8. Abdo EN, Alves LC, Rodrigues AS, et al: Treatment of a centralgiant cell granuloma with intralesional corticosteroid. Br J OralMaxillofac Surg 43:74, 2005

9. Graham RM, Foster ME, Richardson D: An unusual presentationof a central giant cell granuloma and initial treatment with intra-lesional corticosteroids: A case report and review of the litera-ture. J Oral Health Comm Dent 2:65, 2008

10. Rajeevan NS, Soumithran CS: Intralesional corticosteroid injec-

tion for central giant cell granuloma. Int J Oral Maxillofac Surg27:303, 199811. Khafif A, Krempl G, Medina JE: Treatment of giant cell gran-

uloma of the maxilla with intralesional injection of steroids.Head Neck 22:822, 2000

12. Sezer B, Koyuncu B, Gomel M, Gunbay T: Intralesional corti-costeroid injection for central giant cell granuloma: A casereport and review of the literature. Turk J Pediatr 47:75,2005

Table 1. CASES REPORTED IN ENGLISH-LANGUAGE STUDIES OF INTRALESIONAL CORTICOSTEROIDS TO TREAT CEN-

TRAL GIANT CELL GRANULOMA

Case Age Gender Localization Treatment length Resolution time

Carlos and Sedano, 20023 Case 1 31 M Maxilla 20 injections within 60 wk 15-24 weeks

Case 2 34 M Mandible 17 injections within 34 wk NA Case 3 6 M Maxilla 4 injections within 8 wk 15 months

Case 4 2 ,5 F Mandible 4 injections within 8 wk 3 months

Adornato et al, 20015 10 F Mandible Injections given weekly for 6 wk 6 weeks

Kurtz et al, 20016 10 F Mandible Weekly for 6 wk; a second course

administered after 1 yr;

resolution obtained after

approximately 2 yr

In first course healing

began at fifth month; in

second course healing

began at sixth month

Terry et al, 19947 Case 2 9 F Mandible Weekly for 6 wk and additional

2 injenctions

5 months

Case 3 8 M Mandible Weekly for 6 wk 6 monthsCase 4 19 F Mandible Weekly for 6 wk 16 months

Case 5 12 M Mandible Weekly for 6 wk; after 6 months

intralesional injection protocol

repeated

23 months

Abdo et al, 20058 14 F Mandible 1 injection weekly for 3 weeks

and then 1 injection 2 months

later

18 months

Graham et al, 20089 6 M Maxilla Biweekly injections for 12 wk;

after 2.5 months additional

1 injection

4 months

Kermer et al, 19944 40 M Mandible Weekly injections for 5 wk; after

14 months local

corticosteroids were again

applied as described before

NA

Rajeevan et al, 199810 17 F Mandible Weekly injections for 6 wk 6 months

Khafif et al, 200011 36 F Maxilla Weekly injections for 6 wk 6 weeks

Sezer et al, 200512 11 M Mandible Every seven days for a total of

six injections

12 months

Ferretti et al, 20111

16 F Mandible Biweekly injections for 4 wk 4 weeks

Yanik and Aras. Central Giant Cell Granuloma. J Oral Maxillofac Surg 2013.

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