Central Giant Cell Reparative Granuloma of the Maxillary Sinus: Endoscopic Resection and Intranasal Calcitonin Therapy

Abstract

Objectives: Central giant cell reparative granuloma (CGCRG) is an uncommon, nonneoplastic, osteolytic lesion that can display locally aggressive behavior. CGCRG most often involves the mandible. Lesions arising within the paranasal sinuses are far less common. Treatment has historically consisted of surgical excision, typically via open approaches. Recently, calcitonin has been proposed as therapy for CGCRG. We present the case of a young woman with an extensive, aggressive CGCRG of the maxillary sinus who underwent total endoscopic resection followed by adjuvant therapy with intranasal calcitonin. Methods: Case report. Results: A 19-year-old woman presented with a 3-month history of progressively worsening left-sided malar pain and hypesthesia. Physical exam revealed hyperglobus; loose maxillary dentition; a soft, compressible bulge in the left hard palate; and a large mass occupying the left nasal cavity. Computed tomography and magnetic resonance imaging showed a 4 x 4 x 4.8 cm mass within the left maxillary sinus which had eroded the hard palate and inferior orbital wall and displaced the orbital contents superiorly. Biopsy of the lesion was consistent with CGCRG. The patient underwent complete resection via a modified endoscopic, endonasal medial maxillectomy approach. Adjuvant therapy with intranasal calcitonin is underway, and the patient is doing well 3 months post-excision. Conclusions: In this report, we demonstrate a safe, effective, entirely endoscopic resection of an extensive CGCRG. We advocate prompt surgical management of these lesions given their potential for local destruction. Although evidence regarding the use of calcitonin is limited, we suggest considering its use as adjuvant therapy.