Chowdhury Sanjay Kumar Roy, Padha Karan, Singh Sneha, Kumar Rahul, Santra Soumyajit
Oral and Maxillofacial Surgery, AFDC, KG Marg, New Delhi, India.
Oral and Maxillofacial Surgery, MDC Delhi Cantt, New Delhi, India.
J Maxillofac Oral Surg. 2024 Dec;23(6):1508-1515. doi: 10.1007/s12663-023-02082-4. Epub 2024 Jan 28.
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.
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.
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.
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.
中央性巨细胞瘤（CGCT）占颌骨所有良性肿瘤的比例不到7%，有多种非手术和手术治疗方式。在本研究中，作者对中央性巨细胞瘤进行了为期十年的最大规模回顾性分析之一。
对一名操作者在服务医院治疗的157例CGCT病例进行回顾性分析，内容包括基本人口统计学数据、临床和影像学特征、手术干预方案、重建方式及并发症。
157例患者中，男性70例，女性87例。97例（62%）病变位于上颌骨，60例（38%）位于下颌骨。63例患者出现面部不对称，20例患者有感觉异常。影像学上，105个病变为多房性（66%），52个为单房性（33%）。97例上颌CGCT中，60例行上颌骨次全切除术，37例行不摘除眶内容物的上颌骨全切除术。65例行桡侧前臂游离皮瓣重建，15例行腓骨游离皮瓣重建，7例行旋髂深动脉游离皮瓣重建，10例行定制种植体重建。60例下颌CGCT中，37例行整块边缘切除术，13例行节段切除术，10例行半侧下颌骨切除术。20例行腓骨游离皮瓣重建，二十五例行重建钢板重建，15例行定制种植体重建。5例患者（3%）出现部分皮瓣坏死，8例患者（5%）出现伤口裂开，均经保守处理。
正确的诊断和治疗计划对于成功治疗颌面部骨骼中央性巨细胞瘤至关重要。在本研究中，保留5毫米安全切缘的积极切除是首选治疗方式，重建方式包括自体皮瓣如桡侧前臂、腓骨游离皮瓣和旋髂深动脉游离皮瓣，以及异体材料如重建钢板，最近还有定制种植体（PSI）。尽管PSI具有即时功能和牙齿修复功能，同时降低了患者的发病率，是一种令人兴奋且可行的替代治疗方式，可能会彻底改变我们治疗CGCT的方式，但在将PSI视为主要重建选择之前，需要进行长期随机对照试验，比较自体重建和定制种植体。
