Central Giant Cell Tumour of the Maxillofacial Region: A 10-Year Retrospective Analysis.

Background And Aim: Central giant cell tumour (CGCT) accounts for < 7% of all benign tumours of the jaws with various non-surgical and surgical treatment modalities. In this study, the authors perform one of the largest retrospective analysis on central giant cell tumour over a ten-year period.

Material And Methods: A total of 157 cases of CGCT treated in service hospitals by a single operator were retrospectively analysed in terms of basic demographic data, clinical and radiographic features, surgical intervention protocols, reconstruction modalities and complications.

Results: Out of the 157 patients, 70 were male and 87 were female with 97 cases (62%) localised to the maxilla and 60 cases (38%) localised to the mandible. Sixty-three patients presented with facial asymmetry whilst paraesthesia was noted in 20 patients. Radiographically, 105 lesions were multilocular (66%), whereas 52 were unilocular (33%). Out of the 97 maxillary CGCT, subtotal maxillectomy was performed in 60 cases and total maxillectomy without orbital exenteration in 37 cases. Radial forearm free flap reconstruction was done in 65 cases, fibula free flap was done in 15 cases, deep circumflex iliac artery free flap was done in 7 cases and patient-specific implant reconstruction was done in 10 cases. Out of the 60 mandibular CGCT, en block marginal resection was done in 37 cases, segmental resection was done in 13 cases and hemimandibulectomy was done in 10 cases. Fibula free flap was used as the reconstructive option in 20 cases, reconstruction plate was used in 25 cases and patient-specific implant reconstruction was done in 15 cases. Partial flap necrosis was noted in 5 patients (3%) and wound dehiscence in 8 patients (5%) and was managed conservatively.

Conclusion: Proper diagnosis and treatment planning is paramount for successful management of central giant cell tumour of the maxillofacial skeleton. In the present study, aggressive resection keeping a 5-mm safety margin was the preferred treatment modality with the reconstruction options ranging from autogenous options like radial forearm, fibula free flap and deep circumflex iliac artery free flap to alloplastic options like reconstruction plates and more recently patient-specific implants (PSIs). Though PSIs with their immediate functional and dental rehabilitation along with decreased patient morbidity mark an exciting and accessible alternate treatment modality with can revolutionise how we treat CGCT, long-term randomised controlled trials comparing autogenous reconstruction and patient-specific implants are needed before PSIs can be considered the primary reconstructive option.