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139:Orofacial Pain as the First Sign of Central Giant Cell Granuloma[AAOM2021]
EP36073
Poster Title: 139:Orofacial Pain as the First Sign of Central Giant Cell Granuloma[AAOM2021]
Submitted on 29 Mar 2021
Author(s): Vandana Singh, Reid Friesen
Affiliations: University of Alberta, Canada
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 269
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Poster Information
Abstract: Background: Central giant cell granuloma (CGCG) is a benign, non-neoplastic intraosseous lesion, found mainly in the younger age demographic with a female predilection (2:1). The lesions are more commonly found in the mandible and may be unilocular or multilocular. The etiology is unknown and remains controversial. Inflammation, local trauma and hemorrhage have been suggested. CGCG can be further classified as “aggressive” and “non-aggressive” based on radiographic features, and presents clinically as a painless swelling. CGCG has a 15-20% rate of recurrence.

Case Summary: A 23-year-old female was assessed for left-sided facial pain mainly localized on the left mandibular first premolar region. She reported a “sharp, knife” like pain of 10/10 intensity. Extraoral examination did not reveal any pathology. Gentle pressure over the region aggravated her symptoms. No extraoral swelling was noted; intraoral examination was within normal limits. There was no expansion of bone in the region. The pain was localized on the attached gingiva and vestibule on the buccal aspect of the left mandibular canine to the second premolar region. She reported “sharp” pain on palpation. A panoramic radiograph revealed an irregular radiolucency corresponding to the periapical region of the left mandibular canine and first premolar. A CBCT was obtained, which revealed a well-defined non-corticated lesion extending mesiodistally from the left mandibular canine to the apex of the left mandibular second premolar. The lesion occupied the bone marrow, expanded mesiodistally with associated thinning of adjacent cortical bone. Localized cortex perforations were noted. The mandibular canal appeared mildly displaced. Based on the clinical and radiological examination, she was urgently referred for oral surgery. The histopathological examination confirmed the diagnosis of central giant cell granuloma. She is currently being monitored every three months for recurrence.

Conclusion: The case was an unusual presentation of orofacial pain secondary to underlying intraosseous pathology. It is a reminder to the clinician assessing pain patients; intraosseous pathology may mimic tooth pain or neuropathic pain, and further investigation studies, including advanced imaging, are often required when the clinical presentation does not account for the symptomatology.
Summary: Central giant cell granuloma (CGCG) is a benign, non-neoplastic intraosseous lesion, found mainly in the younger age demographic with a female predilection (2:1). The lesions are more commonly found in the mandible and may be unilocular or multilocular. The etiology is unknown and remains controversial. Inflammation, local trauma and hemorrhage have been suggested.

Ask the author questions about this poster:vandana1@ualberta.ca
References: 1. Oliveira TP, Oliveira INF, Pinheiro ECP, Gomes RCF, Mainenti P. Giant sialolith of submandibular gland duct treated by excision and ductal repair: case report. Braz J Otorhinolaryngol. 2016;82:112-5.
2. Gupta A, Rattan D, Gupta R. Giant sialoliths of submandibular gland duct: report of two cases with unusual shape. Contemp Clin Dent. 2013;4:78-80.
3. Fowell C, MacBean A. Giant salivary calculi of the submandibular gland. J Surg Case Rep. 2012; 2012: 6. Ref.: https://goo.gl/VBB4GF
4. Siddiqui SJ, Sialolithiasis: An unusually large submandibular salivary stone. 2002 British Dental Journal 193(2):89-9110.1038/sj.bdj.4801491a
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