Orofacial Pain as the First Sign of Central Giant Cell Granuloma

Singh, Vandana; Friesen, Reid School of Dentistry, University of Alberta

BACKGROUND PANORAMIC RADIOGRAPH & CASE SUMMARY CONCLUSION

Central giant cell granuloma (CGCG) is The case was an unusual

a benign, non-neoplastic intraosseous presentation of orofacial pain
lesion, found mainly in the younger age
secondary to underlying
demographic with a female predilection
intraosseous pathology. It is a
(2:1). The lesions are more commonly
found in the mandible and may be
reminder to the clinician
unilocular or multilocular. The etiology assessing pain patients;
is unknown and remains controversial, intraosseous pathology may
Inflammation, local trauma and mimic tooth pain or neuropathic
hemorrhage have been suggested.
A 23-year-old female was assessed for left-sided facial pain mainly localized on
pain, and further investigation
CGCG can be further classified as
the left mandibular first premolar region. She reported a “sharp, knife” like pain of studies, including advanced
“aggressive” and “non-aggressive”
based on radiographic features, and 10/10 intensity. Gentle pressure over the region aggravated her symptoms. No imaging, are often required when
presents clinically as a painless extraoral swelling was noted; intraoral examination was within normal limits. There the clinical presentation does not
swelling. CGCG has a 15-20% rate of was no expansion of bone in the region. The pain was localized on the attached
account for the symptomatology.
recurrence. gingiva and vestibule on the buccal aspect of the left mandibular canine to the
second premolar region. A panoramic radiograph revealed an irregular
radiolucency corresponding to the periapical region of the left mandibular canine CONE BEAM CT SCAN
INTRAORAL PHOTO
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.