Giant Cell Lesions Of The Oral Cavity

Giant Cell Lesions Of The Oral Cavity

Question. Name the giant cell lesions of the oral cavity. Describe clinical features, radiographic features, and differential diagnosis of central giant cell granuloma.
Answer.

Central Giant Cell Granuloma Lesions of the 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.

Giant Cell Lesions of the Oral Cavity: Causes, Diagnosis, and Treatment

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 cells that characterize lesions
  • Infections:
    • Tuberculosis
    • Hansen’s disease
    • Syphilis
    • Measles.
• 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

Giant Cell Tumor of the Jaw: Symptoms and Radiographic Features

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

Radiographic features of oral giant cell lesions

Central Giant Cell Granuloma Based on Its 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 the second and third decades of life.
• Involvement of the mandible is twice that of to maxilla, with the anterior half showing more incidence. The most common site is the anterior and bicuspid area of the mandible. In the maxilla, the commonly involved sites are the canine fossa and the ethmoid region
• The earliest sign seen is the expansion of bone with premature loosening and shedding of deciduous teeth.
• There is a presence of jaw swelling leading to facial asymmetry.
• Swelling is painless and leads to local discomfort.
• On palpation, there is the presence of tenderness.
• Teeth present in the associated region may get mobile but are vital until they get exfoliated.

Giant cell lesions differential diagnosis

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.

Oral Giant Cell Lesions: Clinical Presentation and Management

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 the mandible, while central giant cell granuloma occurs in the anterior region of the mandible.
• Aneurysmal bone cyst: Does not occur in the anterior region of the 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 has 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 the neck of the tooth, and there is also an association of pumping tooth syndrome.