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Causes

CENTRAL GIANT CELL GRANULOMA Unknown aetiology Probably reactive and not neoplastic Reactive to hemodynamic change : trauma / hemorrhage Young adults (2nd and 3rd decades) Female predominance Only occurs in jaws > in mandible (~70%) Anterior part of jaws Clinically : Swelling of bone Rapid growth Symptomless + 1st detected on routine examination Interpremolar region Non aggressive lesion(more common) : Asymptomatic Slow growth Doesnt perforate cortex Low recurrence Aggressive lesion : Rapid growth Perforates cortex Higher recurrence *Treatment and prognosis Simple enucleation and curettage Recurrence rate following curettage : 15-20% Long term prognosis : good NEED TO EXCLUDE HYPERPARATHYROIDISM by biochemical investigation

Clinical Features

Histopathol Large # of multinucleate , osteolytic giant cells in ogic vascular stroma Features Vascular stroma : rich in small, spindle-shaped cell Giant cells focal aggregation / scattered (often

EXOSTOSES Unknown aetilogy Non-neoplastic May be of dev. origin Reactive to stimulus such as chronic trauma Post surgery (e.g : after free gingival graft) Tarus palatinus Etiology : gen vs env. Midline of hardpalate Can slowly increase in size Peak prevalence : adult (dynamic) Torus mandibularis Lingual aspect (premolar region) Above mylohyoid line 90% bilateral Can correlate with bruxism Palatal tori > common Tori : Rarely seen in childhood Slow growth Varies in size and shape (flat,small elevation to large, nodular growth) Tx : surgical removal for cosmetic reason /denture construction Exostoses Occasionally in other part of jaw Multiple Symmetrical Buccal alveolus (molar region in maxilla) Irregulsritid of alveolus following tooth extraction Enlargement of genial tubercle in edentulous patient Difficult to distinguish with osteoma Entirely dense, cortical bone / cancellous bone with shell of cortical bone

DENSE BONE ISLAND Idiophatic osteoclerosis

Symptomless Discovered as a chance on radiograph Premolar-molar region of mandible 3rd and 4th decades of life No clinical significance except to distinguish from other sclerotic masses (e.g consequences of periapical inflammation / cementosseous dysplasia)

related to vascular channel) Spindle cell : predominant of mononuclear precursor of giant cell fibroblast endothelial cells foci of extravasated erythrocytes + granules of hemosiderin few trabeculae of osteoid/ bone

Radiographi Well demarcated / poorly defined radiolucent lesion c Unilocular / multilocular Thinning / expansion / perforation of cortical plate Root displacement / resorption

Well defined, dense, sclerotic areas Not surrounded by radiolucent space Separated / attached to root apex

Extra info

Giant cell lesions of bone (same histologically) Central giant cell granuloma Giant cell tumor bone Giant cell lesion of hyperthyroidism (brown tumor) Cherubism True Giant cell tumor bone Occur in long bones (very rare in jaws) More aggressive Higher recurrence rate May metastasize in 10% of cases Distinct from CGCG n represent true neoplasm

Localized bony protuberances , non neoplastic Torus palatinus Torus mandibularis Buccal exostosis Palatal exostosis

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