REHABILITATION OF CENTRAL GIANT CELL GRANULOMA WITH ILIAC GREFT AND REMOVABLE SPACE MAINTAINER: CASE REPORT

Öz

Purpose: Central giant cell granuloma is a nonodontogenic pathological lesion that usually located in the mandible and maxilla. The aetiology of giant cell granuloma is undefined. Surgical removal is the most commonly applied therapy. Our aim was to report rehabilitation of central giant cell granuloma with iliac graft and removable space maintainer. Case Report: A 10-years-old child was referred to our clinic complaining of swelling in the mandibular anterior region. The parents of the patient were reported that a surgical operation was done in mandibular anterior region of the patient one year ago. They also reported that this lesion was recurred six months after first surgery. The recurred lesion was removed under general anesthesia, mandibular left central, lateral, canine and first premolar teeth were extracted. Iliac crest graft was harvested and fixed to the mandible. The histopathology report confirms the diagnosis of a central giant cell granuloma. The patient's postoperative 12 months follow-up exam was uneventful. The patient was referred for removable space maintainer. Conclusion: Aggressive lesions such as central giant cell granuloma observed 72% recurrence rate to the literature. Conservative methods such as corticosteroid injection, systemic calcitonin’s success isn’t definite on the recurred lesion. The surgical treatment may cause major defects in jaw bones and changes the facial contours, the repair of the defect with iliac bone graft was performed to solve aesthetic problems and facilitate the further prosthetic rehabilitation

Anahtar Kelimeler

• central giant cell granuloma, iliac crest graft, removable space maintainer

SANTRAL DEV HÜCRELİ GRANÜLOMANIN İLİAK GREFT VE HAREKETLİ YER TUTUCU APAREY İLE REHABİLİTASYONU: OLGU SUNUMU

Öz

Amaç: Santral dev hücreli granüloma sıklıkla mandi- bula ve maksillada lokalize olan, non-odontojenik patolojik bir lezyondur. Etiyolojisi tam olarak bilinme- mektedir. Lezyonun cerrahi olarak uzaklaştırılması en çok uygulanan tedavi yöntemidir. Amacımız bu vakada santral dev hücreli granülomanın iliak greft ve hareketli yer tutucu aparey kullanılarak rehabili- tasyonunu rapor etmektir.

Vaka raporu: 10 yaşındaki erkek hasta kliniğimize mandibula anterior sol bölgede şişlik şikayetiyle başvurdu. Alınan anamnezde, şikayetin olduğu bölgeye yaklaşık 1 yıl önce cerrahi bir müdahale yapıldığı, fakat şişliğin altı ay önce tekrar oluştuğu öğrenildi. Genel anestezi altında lezyon çıkartıldı. Mandibular sol santral, lateral, kanin ve birinci premolar dişler çekildi. Mandibulada oluşan defekt iliak greftle onarıldı. Çıkarılan kitlenin histopatolojik incelemesi yapıldı ve santral dev hücreli granülom tanısı konuldu. Operasyon sonrası yapılan 12 aylık takipte herhangi bir problemle karşılaşılmadı. Daha sonra hastaya hareketli yer tutucu bir aparey yapıldı.

Sonuç: Literatürde santral dev hücreli granülom gibi agresif lezyonların %72 rekürens oranı olduğu görül- mektedir. Rekürens gösteren vakalarda kortikostreoid enjeksiyonu, sistemik kalsitonin uygulaması gibi konservatif yöntemlerin başarısı kesin değildir. Cerrahi tedavi çene kemiklerinde major defektlere neden ola- bilir ve fasiyal konturu bozabilir. Böyle bir durumda de- fektin iliak greftle tamiri estetik problemleri çözecektir ve protezle rehabilitasyon imkanı sunacaktır.

Anahtar Kelimeler

• santral dev hücreli granüloma, iliak greft, hareketli yer tutucu

Kaynakça

1. 1- Waldron CA: Bone pathology. In: Neville BW, Damm DD, Allen CM, Bouquot JE (eds), Oral and maxillofacial pathology. Philadelphia: Saunders, 1995; 453-5.
2. 2- de Lange J, van den Akker HP, van den Berg H. Central giant cell granuloma of the jaw: a review of the literature with emphasis on therapy options. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:603-15.
3. 3- Whitaker SB, Waldron CA. Central giant cell lesions of the jaws. A clinical, radiologic, and histopathologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1993; 75:199-208.
4. 4- Kaffe I, Ardekian L, Taicher S, Littner MM, Buchner A. Radiologic features of central giant cell granuloma of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 81:720-6.
5. 5- Rachmiel A, Emodi O, Sabo E, Aizenbud D, Peled M. Combined treatment of aggressive central giant cell granuloma in the lower jaw. J Craniomaxillofac Surg. 2012; 40:292-7.
6. 6- Gungormus M, Akgul HM. Central giant cell granuloma of the jaws: a clinical and radiological study. J Contemp Dent Pract 2003; 4: 87-97.
7. 7- Stavropoulos F, Katz J. Central giant cell granulomas: a systematic review of the radiographic characteristics with the addition of 20 new cases. Dentomaxillofac Radiol 2003; 31: 213- 7.
8. 8- Yanik S, Aras MH. Management of central giant cell granuloma of mandible using intralesional corticosteroids: case report and review of literature. J Oral Maxillofac Surg. 2013; 71:721-2.

9. 9- de Lange J, Rosenberg AJWP, van den Akker HP, Koole R, Wirds JJ, van den Berg H. Treatment of central giant cell granuloma of the jaw with calcitonin. Int J Oral Maxillofac Surg 1999;28:372- 6.
10. 10- Choi JW, Kraut RA. Management of central giant granuloma of mandible with intralesional triamcinolone injections: a case report. NY State Dent J. 2013;79:34-6.
11. 11- O’Regan EM, Gibb DH, Odell EW. Rapid growth of giant cell granuloma in pregnancy treated with calcitonin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92:532-8.
12. 12- Kurtz M, Mesa M, Alberto P. Treatment of a giant cell lesion of the mandible with intralesional glucocorticosteroids. Oral SurgOral Med Oral Pathol Oral Radiol Endod 2001; 91:636-7.
13. 13- Nogueira RLM, Teixeira RC, Cavalcante RB, Ribeiro RA, Rabenhosrt SHB. Intralesional injection of triamcinolone hexacetonide as an alternative treatment for central giant-cell granuloma in 21 cases. Int. J. Oral Maxillofac Surg 2010: 9:1204- 10.
14. 14- Oda D. Alternative treatment for central giant cell ‘‘reparative’’ granuloma. Adv Anat Pathol 2003; 10:110.
15. 15- Kruse-Lösler B, Diallo R, Gaertner C, Mischke KL, Joos U, Kleinheinz J. Central giant cell granuloma of the jaws: a clinical, radiologic, and histopathologic study of 26 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101:346-54.
16. 16- Kaban LB, Troulis MJ, Ebb D, August M, Hornicek FJ, Dodson TB. Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws. J Oral Maxillofac Surg 2002; 60:1103-11.
17. 17- Chuong R, Kaban LB, Kozakewich H, Perez-Atayde A: Central giant cell lesions of the jaws: a clinicopathologic study. J Oral Maxillofac Surg 1986; 44: 708-13.
18. 18- Waldron CA, Shafer WG: The central giant cell reparative granuloma of the jaws. An analysis of 38 cases. Am J Clin Pathol 1966; 45: 437-47.
19. 19- Rawashdeh MA, Bataineh AB, Al-Khateeb T: Long- term clinical and radiological outcomes of surgical management of central giant cell granuloma of the maxilla. Int J Oral Maxillofac Surg 2006; 35: 60-6.
20. 20- de Lange J, van den Akker HP: Clinical and radiological features of central giant-cell lesions of the jaw. Oral Surg Oral Med Oral Path Oral Radiol Endod 2005; 99: 464-7.
21. 21- Erdoğan Ö, Esen E, Yavuz M: Pharmacological and surgical interventions for the treatment of giant cell tumor of the mandible; report of a case after 5-year follow-up, Atatürk Üniv. Diş Hek. Fak. Derg. 2011; 21, 129-33.
22. 22- Becelli R, Cerulli G, Gasparini G: Surgical and implantation reconstruction in a patient with giant cell central reparative granuloma. J Craniofac Surg 1998; 1: 45-7.
23. 23- De Corso E, Politi M, Marchese MR, Pirronti T, Ricci R, Paludetti G: Advanced giant cell separative granuloma of the mandible: radiological features and surgical treatment. Acta Otorhinolaryngol Ital 2006; 26: 168-72.
24. 24- Infante Cossı`o P, Martinez de Fuentes R, Carranza Carranza A, Torres Lagares D, Gutierrez Pe´rez JL: Recurrent central giant cell granuloma in the mandible: surgical treatment and dental implant restoration. Med Oral Pathol Oral Cir Bucal 2007; 12: 229-32.