Interventions for central giant cell granuloma of the jaws

The central giant cell granuloma (CGCG) of the jaws is a rare benign tumour of the mandible (lower jaw) and the maxilla (upper jaw) characterized by destruction of the bone, loss of symmetry of the face and displacement of teeth and tooth germs, especially in younger patients. Aggressive types of tumours are usually expansive and rapidly grow, causing pain, bleeding, and displaced and loose teeth. The management of CGCG can include conventional surgery with or without medical adjunctive treatment or resection in-bloc for the aggressive variant. Although the most common therapy is surgical curettage, the high recurrence rate, especially in aggressive lesions, has raised concern and led to a search for other treatment options. This review compared primary non-surgical interventions versus primary surgical or other treatments. Although a number of therapies have been proposed for treating central giant cell granuloma of the jaws, our review did not identify evidence from randomised controlled trials to support their use. Our review only identified one study comparing calcitonin to placebo. No significant difference in the proportion of patients with increased volume of more than 10% of the tumour compared to the pretreatment measurement at 3 months of follow-up was found between both groups.

Authors' conclusions: 

We did not find RCTs evaluating the effects of primary surgical versus primary non-surgical interventions for central giant cell granuloma of the jaws. Although a number of non-surgical therapies have been proposed for treating central giant cell granuloma of the jaws, our review did not identify evidence from RCTs to support their use. More research is needed on this topic.

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Background: 

Central giant cell granuloma (CGCG) of the jaws is a rare benign tumour with an unknown aetiology accounting for up to 7% of tumours in the mandible (lower jaw) and the maxilla (upper jaw).

Objectives: 

This systematic review focused on assessing the effects of primary non-surgical versus primary surgical interventions or any other treatment or placebo for treating central giant cell granuloma of the jaws.

Search strategy: 

Relevant randomised controlled trials (RCTs) were identified from the Cochrane Oral Health Group's Trials Register (July 2009); CENTRAL (The Cochrane Library 2009, Issue 3); MEDLINE (1950 to July 2009); EMBASE (1980 to July 2009); and LILACS (1982 to July 2009). We scanned bibliographies of relevant studies for possible references to additional trials as well as prospective clinical trial registries. Eligible RCTs were included regardless of the language of publication.

Selection criteria: 

Randomised controlled trials involving a comparison of primary non-surgical interventions with primary surgical interventions or any other treatment.

Data collection and analysis: 

Two review authors independently assessed eligibility, risk of bias and extracted data. The Cochrane Collaboration statistical guidelines were followed.

Main results: 

We did not find any study evaluating the effects of primary surgical versus primary non-surgical interventions for central giant cell granuloma of the jaws. However, we included and analysed one RCT with unclear risk of bias, evaluating the effects of calcitonin versus placebo for central giant cell granuloma of the jaws. No significant difference was found in the proportion of patients with increased volume of more than 10% of the lesion compared to the pretreatment measurement at 3 months of follow-up (one RCT, 14 participants; risk ratio (RR) 3.00, 95% confidence interval (CI) 0.40 to 22.30).

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