Disease Of Bone Manifested In The Jaws And Fibro-Osseous Lesions
Question 1. Enumerate the fibro-osseous lesion. Discuss the etiology, clinical features, and complications of Paget’s disease.
Answer.
Fibro-osseous Lesions
- Fibro-osseous Lesions of Medullary Bone Origin
-
- Fibrous dysplasia
- Fibro-osteoma
- Cherubism
- Juvenile ossifying fibroma
- Giant cell tumor
- Aneurysmal bone cyst
- Jaw lesions in hyperparathyroidism
- Paget’s disease.
-
- Fibro-osseous Lesions of Periodontal Origin
- Periapical cemental dysplasia
- Florid osseous dysplasia
- Cemento-ossifying fibroma
- Ossifying fibroma.
Read And Learn More: Oral Medicine Question And Answers
Paget’s Disease
It is also called as osteitis deformans.
Paget’s disease is defined as abnormal resorption and apposition of bone in one or more bones.
Fibro-osseous Lesions Etiology
- Circulatory disturbance: It is excessively vascular and vessels are similar to arteriovenous aneurysms
- Genetic and environmental factors: It is transmitted as autosomal dominant trait.
- Disorder of connective tissue biosynthesis.
- Due to vasculitis, trauma, hormonal disorders, degenerative neurological disorders.
Fibro-osseous Lesions Clinical Features
- It is seen in patient of 40 years of age with slight predilection of males.
- It occurs in axial skeleton especially skull, femur, sacrum and pelvis.
- Symptoms:
- Patient needs to buy a hat of large size because of skull enlargement.
- Bone pain is present, which is directed to weight bearing areas.
- Patient can have ill defined neuralgic pain due to restriction of both canals and foramina.
- Deafness due to enrolment of petrous part of temporal bone.
- Mental disturbance, dizziness.
- Signs:
- Bowing of legs.
- Curvature of spine.
- Enlargement of skull.
- Involved bones are warm to touch because of increased vascularity and are prone to fracture.
- Patient looks like a simian, this is because of grotesque facial appearance along with the presence of waddling gait and the short stature.
- Because of broadening and flattening of chest as well as spinal curvature. Patient have waddling gait.
Fibro-osseous Lesions Oral Manifestation of Paget’s disease
- Maxilla is more commonly involved and is bilaterally symmetrical.
- There is presence of migration of the involved teeth. Since migration is seen, patient may have malocclusion. If patient is edentulous, his alveolar bone enlarges and because of this there is poor fit of the denture.
- In maxilla there is increase in the alveolar width which is associated with the flattening of palate.
- As disease enhances, mouth of the patient remains open which exposes the teeth, this is because lips of the patient are too small to cover the enlarged jaws.
- Extracted tooth socket show slow healing and incidence of osteomyelitis is high. If lytic phase of Paget’s disease is going on, there can be excessive bleeding from highly vascular abnormal bones.
Fibro-osseous Lesions Complications of Paget’s disease
- General complications
- Deformities of skeleton
- Limbs fracture
- Compression of spine
- Giant cell lesions occur
- Renal and salivary calculi
- Hypercalcemia.
- Oral complications
- Osteogenic sarcoma
- Osteomyelitis
- Pathological bone fracture
- Facial paralysis.
Question 2. Write short note on fibrous dysplasia.
Answer. It arises from the bone forming mesenchyme in spongiosa and develops by proliferation of fibrous tissue.
Fibrous Dysplasia Etiopathogenesis
- Developmental: According to Jaffe and Lichtenstein, it is a developmental anomaly lead by aberrant activity in bone forming mesenchymal tissue. As per many of the theories it is developmental anomaly as disease start in early life and is active at the time of growth period.
- Endocrine disturbance: As per Sternberg and Joseph, the disorder is a complex endocrine disturbance of whose cause is local tissue susceptibility.
- Genetic: It occurs due to postzygotic mutation in GNAS I i.e. Guanine nucleotide binding protein I gene. If there is mutation in early embryonic period, there is occurrence of polyostotic type of fibrous dysplasia. It mutation is in post natal life, monostotic type of fibrous dysplasia occur.
Fibrous Dysplasia Classification
- Monostotic fibrous dysplasia: Only one bone is involved.
- Polyostotic fibrous dysplasia: More than one bone is involved.
- Jaffe’s type: In this there is involvement of variable number of bones along with pigmented lesions of skin or “café-au-lait” spots.
- Albright’s syndrome: It is the severe form which involves all the bones of body, accompanied by pigmented lesions of skin along with the endocrine disturbances of various types.
Fibrous Dysplasia Clinical Features
- Monostotic fibrous dysplasia.
- Sites: Involve one bone, no extraskeletal effects are present other than occasional pigmented skin lesions. Most frequent sites are ribs, femur, maxilla and mandible.
- Age and sex: Occur in younger children of 10 years of age.
- Swelling is present over affected side.
- Polyostotic fibrous dysplasia.
- Jaffe’s Type:
- Involves multiple bones and female-to-male ratio is 3:1.
- Skin consists of irregularity pigmented light brown melanotic spots called as “cafe-au-lait spot”.
- Most common sites are back, buttocks, thigh, shoulder, chest, neck and face.
- Recurrent bone pain is common problem.
- Skeletal lesions can be unilateral or may involve all the bones of body. Lesions get static with cessation of growth bur proliferation continues in polyostotic form.
- Most common complication is spontaneous fracture.
- In very few cases, continuous extension of the disease can lead to destructive deformity and blindness.
- Jaffe’s Type:
- McCune Albright syndrome
- Found more commonly in the females.
- In addition with the bone deformities, it also show endocrinal disturbances such as precocious puberty, goiter, hyperthyroidism, hyperparathyroidism, Cushing’s syndrome and acromegaly.
- Café-au-lait spots are commonly seen. These are the coffee with milk color spots. An irregular flat area of the increased skin pigmentation is seen.
- There is presence of excessive vaginal bleeding.
- Main sign is the development of secondary sexual features mainly pubic and Axillary hairs along with development of breasts which occur at the age of 5 years. It can also result in crippling deformity or the fracture.
- Mainly the long bones are the one who are frequently affected.
Fibrous Dysplasia Oral Manifestations
- Monostotic
- Maxilla is more commonly affected with majority of changes occurring in posterior region i.e. premolar-molar region.
- There is presence of unilateral facial swelling, which grows slowly with intact overlying mucosa.
- Swelling is mainly painless, but in some of the cases patient complaints of discomfort or frank pain.
- Buccal and cortical plates become enlarged.
- If mandible is involved there is protuberant excrescence of inferior border of mandible occur.
- In the affected area teeth become malaligned and tipped or either displaced.
- Supernumerary teeth can also be encountered. They occur commonly in maxillary midline or mandibular premolar region. Supernumerary teeth often remain impacted or can affect eruption of normal teeth.
Fibrous Dysplasia Craniofacial
- It involves maxillary sinus, zygomatic process, floor of orbit and sometimes base of skull.
- This causes severe malocclusion, marked facial deformity, anosmia, deafness and blindness.
- Most common sign is proptosis of an affected eye.
Fibrous Dysplasia Polyostotic
- Jaws become deformed and show expansion along with symmetry of the facial bones. Ballooning of jaw is common characteristic.
- There is disturbed eruption pattern of teeth due to loss of support of developing teeth.
- Intraoral pigmentation can also be appreciated in some of the cases.
Fibrous Dysplasia Radiographic Features
For radiographic features in detail refer to Ans 8 of same chapter.
Fibrous Dysplasia Diagnosis
- Clinical diagnosis: Presence of painless swelling in maxillary region along with intact mucosa. Café-au-lait spots are seen.
- Radiographic diagnosis: Both ground glass appearance and granular appearance is seen.
- Laboratory diagnosis:
- Serum alkaline phosphatase levels are increased.
- On histological examination fibrous bone is seen in compact stroma of interlacing collagen fibers. Irregular trabeculae of bone are seen scattered throughout the lesion with no definite pattern of arrangement. Some of the trabeculae are C shaped and are revealed as Characteristic Chinese letter pattern.
Fibrous Dysplasia Management
- Surgical removal of lesion is done.
- Osseous contouring is done to correct deformity for aesthetic purposes.
Question 3. Write short note on ossifying fibroma.
Answer. Ossifying fibroma is a benign fibro-osseous neoplasm which is non-odontogenic, well defined and is rarely encapsulated consisting of fibrous tissue with various amounts of mineralized material which is similar to bone or cementum.
Ossifying Fibroma Clinical Features
- It is seen during third or fourth decades of life with females more commonly affected.
- It can arise from any part of facial skeleton and skull. The lesion is seen principally in the jaw, but is also seen in orbitofrontal bone, nasopharynx, paranasal sinus and base of skull. Premolar-molar area is mostly affected in mandible above the inferior alveolar canal. In maxilla, it occurs often in canine fossa and zygomatic arch region.
- Facial asymmetry is seen in some of the cases.
- In maxilla, symptoms are nasal stuffiness and epiphora of affected side.
- The signs present are exophthalmos with visual disturbances, these depends on extent of compression of its orbital content by tumor.
- Lesion grows slowly along with displacement of teeth.
- Bony cortex and covering mucosa remain intact along with cortical expansion.
- Initially the lesion is slow growing with rapid increase in size usually in shorter duration of time.
Ossifying Fibroma Radiographic Features
- Borders of the lesion are well defined. Usually a thin radiolucent line, represent fibrous capsule which separates it from surrounding bone. At times, the bone present next to the lesion develop sclerotic border.
- During early stage, solitary cyst like osteolytic lesions are seen which are present without the periosteal reaction. In this type where abnormal bone is present, pattern is same as seen in fibrous dysplasia or either wispy or flocculent pattern is seen. Lesions which produces more of cementum like material can consists of solid amorphous radiopacities i.e. cementicles which are same as seen in cemental dysplasia. Lesion show mixed radiopaque/radiolucent appearance.
- Growth of the tumor is concentric inside the medullary part of bone with outward expansion which is equal in all directions. The lesion can grow and occupy complete maxillary sinus, expanding its wall in outward direction; moreover a bony partition is appreciated between the internal aspect of remaining sinus and the tumor. If it involves the orbit, it can displace the globe.
- Expanding lesion show displacement of teeth. Lamina dura of involved teeth is missing. Resorption of teeth can be seen.
Ossifying Fibroma Diagnosis
- Clinical diagnosis: This is not specific, only facial symmetry is appreciable.
- Radiological diagnosis: Lesion show mixed radiopaque/radiolucent appearance along with presence of sclerotic border. Teeth displacement can also be appreciated.
- Laboratory diagnosis: Here connective tissue stroma shows cellular fibrous connective tissue which consists of cementum like spherules. Fibroblasts are presence in abundance with flat and elongated nuclei inside the network of interlacing collagen fibers.
Ossifying Fibroma Differential Diagnosis
During Early Radiolucent Stage
- Primordial cyst: Associated with missing permanent tooth, which is not seen in ossifying fibroma.
- Residual cyst: Previous history of extraction is seen.
- Ameloblastoma: This is seen in posterior region of mandible and there is presence of paresthesia of lip. It also has multilocular appearance.
- Periapical cemental dysplasia: Its most common site is apices of vital teeth. It is seen in mandibular incisor region while cementifying fibroma is seen commonly in premolar-molar region.
- Adenomatoid odontogenic tumor: It is always associated with impacted maxillary canine in young patient.
Mixed Radiopaque Radiolucent Lesion
- Calcifying epithelial odontogenic tumor: It is located commonly in posterior body and ramus of mandible.
- Osteoid osteoma: Seen commonly in males under 30 years of age and not seen so frequently in the jaws while ossifying fibroma is seen commonly in jaws and is seen commonly in females during 3rd or 4th decades of life. It leads to pain in night while ossifying fibroma remains asymptomatic.
- Osteoblastoma: Its location in head and neck region is very rare.
- Osteosarcoma: It shows aggressive growth, cortical bone destruction, invade the surrounding soft tissues and along periodontal ligament while ossifying fibroma shows benign growth.
- Paget’s disease: It shows characteristic cotton wool appearance as well as enlargement of the affected bone.
- Fibrous dysplasia: It shows homogeneous radiopaque region with internal architecture which is granular and obliterates normal bone space. It consists of ill defined borders and blend in surrounding normal bone.
- Benign cementoblastoma: This occurs during second and the third decades of life in the posterior mandibular region. It is attached to the part of root with the frequent root resorption. Ossifying fibroma is not attached to the roots but yes it absorbs the roots.
Ossifying Fibroma Mature Stage
- Condensing osteitis: It commonly occurs at periapex of nonvital tooth. Radiolucent rim is absent.
- Complex odontoma: It has non-uniform density and this seldomly occur periapically.
- Periapical idiopathic osteosclerosis: This commonly occurs in vital teeth at periapical region. Ossifying fibroma is smoothly contoured and is round or ovoid in shape while the periapical idiopathic osteosclerosis is irregular in shape and lacks radiolucent rim.
- Periapical spherical type of hypercementosis: It remains attached to the part of root and get separated from periapical bone by radiolucent periodontal ligament space which surrounds the complete root.
Ossifying Fibroma Management
- Enucleation: Small encapsulated lesions are treated by conservative enucleation.
- Resection: If inferior border of mandible is involved or if the tumor extend into the maxillary sinus.
Question 4. Write short note on radiographic appearance of Paget’s disease.
Answer. The radiographic appearance of Paget’s disease consists of three radiographic stages
Paget’s disease Early Radiolucent Stage
- It is seen in mandible. Inferior cortex may appear osteoporotic and possess a laminated structure, as the trabeculae may be altered in shape or decreased in number, and they can be long or align themselves in the horizontal linear pattern. This happen more in posterior to bicuspid region. In anterior region, bony trabeculae are coarse and are straight and normal, but they intersect producing bone spaces which are usually larger than the normal. Coarse and sparse trabeculae sometimes converge towards the midline of mandible which is suggestive of Paget’s disease.
- Root resorption is common.
- Osteoporosis circumscripta: In the skull, early lytic lesion may be seen as discrete radiolucent areas termed as osteoporosis circumscripta. The margins are irregular. There is appearance of denser bone around radiolucency.
Paget’s disease Ground-Glass Appearance
- There are rounded radiopaque patches of abnormal bone of greater density within the radiolucent bone, within which it is not possible to see any actual bone structure.
- These densities may be a centimeter large or only a few millimeters in diameter.
- This pattern is much more common in the mandible than in maxilla.
A Dense, More Radiopaque Stage
- In later stage, rounded radiopaque patches of abnormal bone are often seen giving an impression of cotton wool.
- As the fully opacified area becomes more numerous and enlarged, they tend to coalesce.
- The bone is denser and appears whiter on radiograph.
- Bone is enlarged and appears nearly four times its normal thickness over the lateral radiographs. Outer cortex can be thinned but remains intact and appear laminated when seen in occlusal radiograph.
- At times, irregular enlargement of alveolar process is seen which become prominent and bulgy.
- Mandible appears to be largely prognathic.
- In maxilla, the disease can encroach maxillary sinus which involves the floor which may appear more granular and less apparent than sharp boundaries. Air space is not diminished to greater extent.
- Involved teeth show hypercementosis while the lamina dura and periodontal ligament space is seen obliterated around hypercementosed roots. Normal roots shows ankylosis.
- If osteogenic sarcoma develops, it produces frank destruction of bone . In some of the cases soft issue shadow can be seen.
Question 5. Write short note on Albright’s syndrome.
Answer. It is also known as McCune-Albright syndrome
In addition with the bone deformities, it also shows endocrinal disturbances such as precocious puberty, goiter, hyperthyroidism, hyperparathyroidism, Cushing’s syndrome and acromegaly.
- Café-au-lait spots are commonly seen. These are the coffee with milk color spots. An irregular flat area of the increased skin pigmentation is seen.
- There is presence of excessive vaginal bleeding.
- Main sign is the development of secondary sexual features mainly pubic and Axillary hairs along with development of breasts which occur at the age of 5 years. It can also result in crippling deformity or the fracture.
- Mainly the long bones are the one who are frequently affected.
Albright’s syndrome Differential Diagnosis
- Peutz-Jeghers syndrome: Multiple pigmented macules are seen over the skin which are mostly restricted to areas which encircles body orifices.
- Addition’s disease: In adrenal insufficiency, various discrete macules are visible.
Question 6. Name giant cell lesions of oral cavity. Describe clinical features, radiographic features and differential diagnosis of central giant cell granuloma.
Answer.
Central Giant Cell Granuloma Lesions of Oral Cavity
According to the nature of Different Pathologic Conditions
- Infections
- Bacterial
- Viral
- Fungal
- Protozoal
- Parasitic.
- Fibro-osseous lesions and osteodystrophies
- Immunologic
- Idiopathic
- Orofacial granulomatosis
- Reaction to materials
- Benign and malignant tumors.
In this classification giant cells are categorized into three categories,
-
- Giant cells are the main cause for the pathology
- Giant cells characterize these lesions
- Lesions that may be associated with giant cells.
- Main cause for the pathology
- Giant cell granuloma
- Peripheral
- Central.
- Giant cell tumors
- Giant cell fibroma
- Hyperparathyroidism.
- Giant cell granuloma
- Giant cells that characterize lesions
- Infections:
- Tuberculosis
- Hansen’s disease
- Syphilis
- Measles.
- Infections:
- Granulomatous lesions:
- Wegener’s granulomatosis
- Orofacial granulomatosis
- Pulse granuloma
- Sarcoidosis
- Lesions in bone:
- Aneurysmal bone cyst
- Cherubism
- Paget’s disease
- Foreign body lesions:
- Silicosis
- Berylliosis
- Malignancies:
- Lymphoma—Hodgkin’s disease
- Bronchogenic carcinoma
- Carcinoma of thyroid
- Miscellaneous
- Xanthoma
- Giant cell arteritis
Lesions that may be associated with giant cell
- Malignancies:
- Multiple myeloma
- Ewing’s sarcoma
- Fibrosarcoma
- Chondrosarcoma
- Fibro-osseous lesions:
- Osteoblastoma
- Fibrous dysplasia
- Cemento-ossifying fibroma
- Radicular cyst
Central Giant Cell Granuloma Based on their Origin
- Epithelially derived, i.e. Warthin-finkeldey giant cells, tumour giant cells.
- Stromally derived, i.e. Reed-Sternberg giant cells.
Central Giant Cell Granuloma Clinical Features
- It occurs in young adults during second and third decades of life.
- Involvement of mandible is twice as compared to maxilla with anterior half showing more incidence. Most common site is anterior and bicuspid area of mandible. In maxilla, the commonly involved sites are canine fossa and ethmoid region
- Earliest sign seen is the expansion of bone with premature loosening and shedding of deciduous teeth.
- There is presence of jaw swelling leading to facial asymmetry.
- Swelling is painless and leads to local discomfort.
- On palpation, there is presence of tenderness.
- Teeth present in the associated region may get mobile but are vital until they get exfoliated.
Central Giant Cell Granuloma Radiographic Features
- It is either the unilocular or multilocular radiolucency occupying the body of mandible and extend past the midline to opposite side.
- As the growth occur it leads to bossing of buccal cortex i.e. variable bulging or undulation of cortical contour.
- Borders can be smooth, undulating, moderately well defined and moderately well corticated.
- Radiograph shows honeycomb pattern, i.e. bony trabeculae are present within their bony contour and are tend to be mild wavy on close inspection.
- Presence of displacement of adjacent teeth, tooth bud and resorption.
Central Giant Cell Granuloma Differential Diagnosis
- Ameloblastoma: Uncommon in young age while central giant cell granuloma occurs in young age. Ameloblastoma occur in posterior region of mandible while central giant cell granuloma occurs in anterior region of mandible.
- Aneurysmal bone cyst: Does not occur in anterior region of mandible. On aspiration aneurysmal bone cyst yields blood.
- Traumatic bone cyst: Does not show mobility of teeth and expansion of overlying bone cortex.
- Odontogenic myxoma: It is associated with a missing or impacted tooth. It is multiloculated and have typical honeycomb appearance.
- Brown tumor of hyperthyroidism: Elevated serum calcium levels are present.
- Cherubism: Present bilaterally, familial incidence present, Does not cross midline.
- Central hemangioma: This shows localized bleeding around neck of teeth and there is also association of pumping tooth syndrome.
Question 7. Write short note on radiographic appearance of fibrous dysplasia.
Or
Write short note radiographic features of fibrous dysplasia.
Answer.
Fibrous Tissue Lesion Showing Predominance
- Early lesions appear radiolucent with ill-defined borders.
- Margins of the lesion are well defined and have tendency to blend with surrounding bone.
- Lesion can be unilocular bit sometimes bony septa are apparent forming an impression of multilocular cavity.
- Margins of radiolucent area are surrounded by wide band of increased density which is granular in appearance.
- Loss of lamina dura is seen.
- Presence of resorption of roots.
Lesion Showing Mixed Appearance
- Since the lesion consists of distribution of fibrous as well as osseous tissue, there is presence of mixed, i.e. radiopaque and radiolucent appearance.
- New bone take the form of small opacities of poor density. When these become large they appear granular.
Mature Radiopaque Lesion
- Here orange-peel appearance is present. Normal bone is replaced by stippled appearance which looks like ring of orange. Teeth get displaced over the affected area.
- As the disease affects the mandible its vertical depth is increased and inferior border seem to be ribbon-like cortex. In various cases, localized area present at the cortex become lost and there is presence of smooth curved projection is seen at inferior margin of mandible. This is known as thumb print appearance.
- As the maturation of disease progresses bony trabeculae, which are dysplastic increase both in size and number. This gives smoky mottled appearance.
- Another characteristic appearance is of ground glass also known as granular. It can show areas of whorled amorphous partially calcified materials which are well circumscribed.
Obisesan et al Radiographic Classification of Fibrous Dysplasia Lesions
- “Paeu d’orange” or orange peel: Here alternating areas of granular density and radiolucency give radiographic appearance resembling to peel of the orange.
- Whorled plaque like type: Here, matrix of well circumscribed lesion consists of plaques of amorphous material of intermediate radiodensity, which on close examination are seen to be arranged in whorled finger print appearance.
- Diffuse sclerotic type: Lesions are seen as homogeneous dense areas, which merge with normal bone.
- Cyst like type: Here, lesion is radiolucent, unilocular or more often, multilocular with well defined margins.
- Pagetoid type: Here affected area of bone markedly expands and show alternating areas of radiopacity and radiolucency, as seen in Paget’s disease
- Chalky type: It is a well circumscribed lesion which consists of an amorphous dense radiopaque material.
Fibrous Tissue CT Features
- It evaluate the extent of facial lesions mainly the orbit.
- CT shows expansion of involved bones in heterogeneous pattern with scattered or confluent islands of bone formation.
- In the dense lesions CT attenuation values reach up to 34 to 513 Hounsfield units.
Question 8. Classify fibro-osseous lesions. Discuss clinical features, radiographic features and radio-differential diagnosis of fibrous dysplasia.
Answer. For classification of fibro-osseous lesions, refer to Ans 1 of same chapter.
For clinical features, refer to Ans 2 of same chapter.
For radiographic features in detail refer to Ans 8 of same chapter.
Radio-differential Diagnosis
- Osteolytic Stage of Fibrous Dysplasia
- Central giant cell granuloma: It shows faint wispy trabeculae while fibrous dysplasia show calcification or granular appearance.
- Traumatic bone cyst: Cortical bulging is absent along with displacement of involved teeth.
- Dental cyst: It shows well-defined cortex which is smooth whereas in fibrous dysplasia the cortex is wider and more granular.
- Chronic osteitis: In this, roots of pulpless teeth are involved.
- Mottled Stage of Fibrous Dysplasia
- Lymphoma of bone: It is irregular and bizarre in its radiographic appearance whereas in fibrous dysplasia smooth and well-contoured external bony borders are maintained.
- Osteoblastic metastatic carcinoma: It does not show monotonous radiographic pattern-like fibrous dysplasia.
- Osteosarcoma: It shows sun-burst appearance. It also has Codman’s triangle while these features are absent in fibrous dysplasia.
- Cementifying and Ossifying fibroma: Margins are welldefined in cementifying and ossifying fibroma, while in fibrous dysplasia they are indistinct and also blends with surrounding normal bone.
- Mature Stage of Fibrous Dysplasia
- Paget’s disease: It produces lesions with ground glass appearance but overall effect is of rarefaction and not radiopacities.
- Giant cell lesion of hyperthyroidism: Due to change in normal trabecular pattern causes ground-glass appearance of numerous small and randomly oriented trabeculae. Demineralization and thinning of cortical boundaries is present.
Question 9. Write short note on central giant cell granuloma.
Answer. Central giant cell granuloma is the fibro-osseous lesion of jaw.
Central Giant Cell Granuloma Types
- Non-aggressive: This shows slow growth and have benign behavior.
- Aggressive: It shows rapid growth and is a destructive lesion.
For clinical features, radiographic features and differential diagnosis refer to Ans 7 of same chapter.
Central Giant Cell Granuloma Diagnosis
- Clinical diagnosis: Presence of expansile swelling in anterior region of mandible.
- Radiological diagnosis: Radiolucency crossing the midline is suggestive of central giant cell granuloma
- Laboratory diagnosis: Biopsy shows multinuclear giant cells, loose fibrillar connective tissue stroma.
Central Giant Cell Granuloma Management
- Curettage of the lesion should be done thoroughly.
- Weekly injection of corticosteroids i.e. triamcinolone acetonide are directly injected in tumor.
- Administration of salmon calcitonin may lead to resolution of lesion. This is given daily for a year as intradermal injection or as nasal spray.
- Partial resection of aggressive tumor can be done
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