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The role for calcitonin treatment
Symposia The treatment of central giant cell lesion is primarily surgical. However, the role of other modalities needs to be investigated further to allow adequate and repeatable results with regard to cure and recurrence rate. References Bataineb A: JOMS 60:756, 2002 Chuong R: JOMS 44:708, 1986 Rajeevan N: Int JOMS 27:303, 1998
The Role for Intralesional Steroids Bill C. Terry, DDS, Chapel Hill, NC Giant cell lesions of the jaws are common and have been reported as occurring second only to odontogenic cysts in the mandible. These benign lesions are seen often in young people, may cause pain, neurosensory disturbances, and exhibit rapid expansion with bone destruction and tooth root reposition. For years surgical removal has been the treatment method of choice with good results. However, surgical removal by local excision or in aggressive lesions to uninvolved bone margins often resulted in loss of teeth and adjacent structures and in some instances continuity defects. Complex reconstructive procedures are then required for functional and aesthetic restoration. An alternative non-surgical method for managing giant cell lesions was suggested by Dr Francis V. Howell of La Jolla, California. This treatment consisted of intralesional steroid injections and was based on his observations of the microscopic similarities between sarcoidosis and central giant cell lesions. He reasoned that similar therapeutic regimens would be of value. Although the mechanism of action of steroids on these lesions is not known, there is apparently an inhibition of osteoclastic activity resulting in rapid resolution including bone regeneration and return to normal function as well as bone contours. A number of patients have been managed with an intralesional steroid injection protocol with excellent results. In successful cases the lesions either heal without surgical intervention or were reduced to a size that allowed conservative surgical removal without sacrifice of teeth or other adjacent structures. Representative cases and long-term results will be discussed. References Eisenbud L, Stern M, Rothberg M, et al: Central giant cell granulomas of the jaws: Experiences in the management of 37 cases. J Oral Maxillofacial Surg 46:376, 1988 Pharoah MJ, IIeersche JNM: Dexamethosone inhibits formation osteoclastlike cells in bone marrow cultures. J Dent Res 65:1006, 1986 Gold L (ed): Oral and Maxillofacial Surgery Clinics of North America.
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Terry B and Jacoway J. Management of central giant cells Lesions—an alternative to surgical Therapy. August 1994
The Role for Calcitonin Treatment M. Anthony Pogrel, DDS, MD, San Francisco, CA The rationale for the use of subcutaneous calcitonin injections for the management of central giant cell granulomas stems from the fact that histologically they are identical to the brown tumor of hyperparathyroidism. Therefore, there may be an as-of-yet undiscovered parathormone-like hormone causing this condition. Salmon calcitonin is the agent normally used, and although it is obtainable as a subcutaneous injection or a nasal spray, calcitonin injections have consistent absorption and consistent blood levels. We have now treated 10 patients with this technique to completion, and by giving 100 units of subcutaneous calcitonin daily for 18 months in all cases the central giant cell granulomas resolved both clinically and radiologically. Biopsies carried out on selected cases showed disappearance of the giant cells. In one case there was a recurrence of the lesion some 18 months after discontinuation of the calcitonin, and it was recommenced after that time and resolved the second time and currently has stayed resolved some six years later. The exact mechanism of action of calcitonin is still unknown, and it is possible that it actually accelerates a natural healing property of these lesions, reflecting their original description as “reparative giant cell granulomas.” References Harris M: Central giant cell granulomas of the jaws regress with cacitonin therapy. Br J Oral Maxioolfac Surg 31:89, 1993 Pogrel MA, Regezi JA, Harris ST, et al: Calcitonin treatment for central giant cell granulomas of the mandible. J Oral Maxillofac Surg 57:848, 1999 Penfold CN, Evan BT: Giant cell lesions complicating Paget’s disease of bone and their response to calcitonin therapy. Br J Maxillofac Surg 31:267, 1993
The Role of Alpha Interferon Thomas B. Dodson, DMD, MPH, Boston, MA The absence of a basic understanding of the biology of giant cell lesions makes their management both challenging and controversial. There are no biologic markers of clinical activity. The natural history of giant cell lesions is unclear. We are not even confident of the tumor cell of origin. At our institution, treatment of giant cell lesions is dictated by their clinical behavior, that is, aggressive versus nonaggressive. The purpose of this presentation is to review the rationale for selecting alpha-interferon to manage aggressive giant cell lesions and to summarize our results to date. AAOMS • 2003
The Role for Intralesional Steroids Bill C. Terry, DDS, Chapel Hill, NC Giant cell lesions of the jaws are common and have been reported as occurring second only to odontogenic cysts in the mandible. These benign lesions are seen often in young people, may cause pain, neurosensory disturbances, and exhibit rapid expansion with bone destruction and tooth root reposition. For years surgical removal has been the treatment method of choice with good results. However, surgical removal by local excision or in aggressive lesions to uninvolved bone margins often resulted in loss of teeth and adjacent structures and in some instances continuity defects. Complex reconstructive procedures are then required for functional and aesthetic restoration. An alternative non-surgical method for managing giant cell lesions was suggested by Dr Francis V. Howell of La Jolla, California. This treatment consisted of intralesional steroid injections and was based on his observations of the microscopic similarities between sarcoidosis and central giant cell lesions. He reasoned that similar therapeutic regimens would be of value. Although the mechanism of action of steroids on these lesions is not known, there is apparently an inhibition of osteoclastic activity resulting in rapid resolution including bone regeneration and return to normal function as well as bone contours. A number of patients have been managed with an intralesional steroid injection protocol with excellent results. In successful cases the lesions either heal without surgical intervention or were reduced to a size that allowed conservative surgical removal without sacrifice of teeth or other adjacent structures. Representative cases and long-term results will be discussed. References Eisenbud L, Stern M, Rothberg M, et al: Central giant cell granulomas of the jaws: Experiences in the management of 37 cases. J Oral Maxillofacial Surg 46:376, 1988 Pharoah MJ, IIeersche JNM: Dexamethosone inhibits formation osteoclastlike cells in bone marrow cultures. J Dent Res 65:1006, 1986 Gold L (ed): Oral and Maxillofacial Surgery Clinics of North America.
22
Terry B and Jacoway J. Management of central giant cells Lesions—an alternative to surgical Therapy. August 1994
The Role for Calcitonin Treatment M. Anthony Pogrel, DDS, MD, San Francisco, CA The rationale for the use of subcutaneous calcitonin injections for the management of central giant cell granulomas stems from the fact that histologically they are identical to the brown tumor of hyperparathyroidism. Therefore, there may be an as-of-yet undiscovered parathormone-like hormone causing this condition. Salmon calcitonin is the agent normally used, and although it is obtainable as a subcutaneous injection or a nasal spray, calcitonin injections have consistent absorption and consistent blood levels. We have now treated 10 patients with this technique to completion, and by giving 100 units of subcutaneous calcitonin daily for 18 months in all cases the central giant cell granulomas resolved both clinically and radiologically. Biopsies carried out on selected cases showed disappearance of the giant cells. In one case there was a recurrence of the lesion some 18 months after discontinuation of the calcitonin, and it was recommenced after that time and resolved the second time and currently has stayed resolved some six years later. The exact mechanism of action of calcitonin is still unknown, and it is possible that it actually accelerates a natural healing property of these lesions, reflecting their original description as “reparative giant cell granulomas.” References Harris M: Central giant cell granulomas of the jaws regress with cacitonin therapy. Br J Oral Maxioolfac Surg 31:89, 1993 Pogrel MA, Regezi JA, Harris ST, et al: Calcitonin treatment for central giant cell granulomas of the mandible. J Oral Maxillofac Surg 57:848, 1999 Penfold CN, Evan BT: Giant cell lesions complicating Paget’s disease of bone and their response to calcitonin therapy. Br J Maxillofac Surg 31:267, 1993
The Role of Alpha Interferon Thomas B. Dodson, DMD, MPH, Boston, MA The absence of a basic understanding of the biology of giant cell lesions makes their management both challenging and controversial. There are no biologic markers of clinical activity. The natural history of giant cell lesions is unclear. We are not even confident of the tumor cell of origin. At our institution, treatment of giant cell lesions is dictated by their clinical behavior, that is, aggressive versus nonaggressive. The purpose of this presentation is to review the rationale for selecting alpha-interferon to manage aggressive giant cell lesions and to summarize our results to date. AAOMS • 2003