Surgical treatment, oral rehabilitation, and orthognathic surgery after failure of pharmacologic treatment of central giant cell lesion : a case report

Abstract

Although pharmacologic treatments for central giant cell lesions have gained much emphasis, these treatment modalities do not always have successful outcomes, and surgical treatment may be necessary. The purpose of the present study was to report a case of aggressive central giant cell lesion initially treated by nonsurgical methods without satisfactory results, necessitating segmental mandibular resection for definitive treatment and oral rehabilitation. A 20-year-old woman was diagnosed with an aggressive central giant cell lesion in the mandible. The patient was first treated with intralesional corticosteroid injections. Subsequently, the lesion increased in size. Therefore, a second pharmacologic treatment was proposed with salmon calcitonin nasal spray, but no signs of a treatment response were noted. Because of the lack of response, surgical excision was performed, and a mandibular reconstruction plate was installed. At 12 months after surgical resection, the patient underwent mandibular reconstruction with bone grafts. After 6 months, 7 dental implants were installed, and fixed prostheses were made. After installation of the prostheses, the patient experienced persistent mandibular laterognathism, and a mandibular orthognathic surgery was performed to correct the laterognathia. The follow-up examination 4 years after orthognathic surgery showed no signs of recurrence and good facial symmetry.