CBCT Report Interpretation - Detailed History Taking (OMR Department)

I. PATIENT DEMOGRAPHICS (For Case Sheet)

II. CBCT FINDINGS - SYSTEMATIC RADIOGRAPHIC DESCRIPTION

A. Location and Extent

• Primary site: Anterior mandible (symphysis and parasymphysis region), extending across the midline
• Extent: Spans from right parasymphysis to left mandibular body, reaching into the molar region on the left side
• Vertical extent: The lesion occupies the full height of the mandibular body - from alveolar crest to inferior border
• Horizontal (buccolingual) extent: Massively expanded, widening the mandible several times its normal buccolingual dimension
• Midline crossing: The lesion crosses the midline - a characteristic (though not pathognomonic) feature of CGCG reported in ~27% of cases (Tahmasbi-Arashlow et al., 2022 [PMID: 35799967])

B. Size and Shape

• Large lesion (multilocular, balloon-like expansion)
• Shape: Globular/ovoid with a teardrop configuration visible on sagittal and coronal views
• The panoramic reconstruction confirms a massive expansile radiolucent lesion

C. Borders and Margins

• Well-demarcated with a partially corticated border
• Scalloped margins at some aspects
• Partly well-defined with a scalloped outline - consistent with published CGCG radiographic patterns (Zengin et al., 2025 [PMID: 41331443])

D. Internal Structure

• Mixed density internal architecture
• Wispy internal septae / trabeculation visible within the lesion
• Ground-glass/granular internal pattern - reflects the fibrocellular stroma with scattered mineralization
• The lesion is NOT purely radiolucent - internal heterogeneity is consistent with CGCG's fibroangiomatous and giant-cell containing stroma

E. Locularity

• Multilocular appearance (consistent with large lesion size)
• Published data confirms: larger CGCGs are statistically more likely to be multilocular, and mean volume of multilocular lesions is significantly greater than unilocular ones (Tahmasbi-Arashlow et al., 2022)

F. Cortical Plate Changes - CRITICAL FINDINGS

G. Effects on Adjacent Teeth

• Root displacement of associated teeth visible
• Likely root resorption (to be confirmed on higher magnification views)
• Tooth roots are embedded within or surrounded by the lesion mass
• The panoramic reconstruction shows the teeth appear displaced/tilted

H. Effects on Other Structures

• Inferior alveolar canal: Position likely altered by mass effect - to be assessed for displacement
• Mental foramen: Likely displaced inferiorly
• No obvious involvement of the condyle or coronoid process based on the images
• Maxillary sinus: Appears uninvolved (lesion confined to mandible)

III. CBCT INTERPRETATION SUMMARY FOR CASE RECORD

"A large, multilocular, expansile radiolucent lesion with mixed internal density, wispy internal septa, well-demarcated scalloped borders, and severe thinning with focal perforation of both buccal and lingual cortical plates is identified in the anterior mandible, crossing the midline from the right parasymphysis region to the left mandibular body. The lesion occupies the full height of the mandible in the involved region with massive buccolingual expansion. These CBCT features are consistent with the histologically confirmed diagnosis of Central Giant Cell Granuloma (CGCG) - aggressive type, given cortical perforation and large lesion volume."

IV. HISTORY TAKING GUIDE FOR OMR DEPARTMENT

Chief Complaint

• Swelling of the lower jaw (anterior/lower front region)
• Duration: _____ (CGCG typically slow-growing over months)
• Pain: Present / Absent (60% of cases report swelling, 17% report pain - Zengin 2025)
• Paraesthesia of lower lip/chin (mental nerve involvement if IAN compressed)

History of Present Illness

• Onset: gradual / sudden
• Progression: slow / rapidly enlarging (rapid growth suggests aggressive CGCG)
• Any history of trauma to the region
• Previous treatment attempted

Relevant Medical History (MANDATORY for CGCG)

1. Hyperparathyroidism - Brown tumors are histologically indistinguishable from CGCG; serum calcium, PTH, phosphate levels required
2. Paget's disease of bone - older patients but should be excluded
3. Cherubism - autosomal dominant, bilateral jaw involvement
4. Noonan syndrome / LEOPARD syndrome - CGCG can be a manifestation
5. Any history of renal disease (secondary hyperparathyroidism)
6. Family history of jaw lesions (cherubism is hereditary)
7. Menstrual history - hormonal factors implicated in CGCG

Drug History

• Calcium channel blockers, bisphosphonates, anti-RANKL agents (affect bone metabolism and treatment planning)

Investigations to Record/Correlate

• Serum calcium, phosphate, alkaline phosphatase, PTH levels
• Complete blood picture
• Incisional biopsy report (histology already available - CGCG)

V. HISTOLOGICAL CORRELATION (CGCG - What the Biopsy Shows)

VI. DIFFERENTIAL DIAGNOSIS TO DOCUMENT

1. Central Giant Cell Granuloma (confirmed) - classic location, age, sex
2. Brown tumor of hyperparathyroidism - histologically identical; must rule out biochemically
3. Ameloblastoma - multilocular expansile; however, lacks CGCG's crossing of midline pattern
4. Odontogenic Keratocyst (OKC/KCOT) - can be multilocular, expansile
5. Aneurysmal Bone Cyst - expansile, can perforate cortex, but rapid history
6. Odontogenic myxoma - multilocular soap-bubble, typically posterior mandible

VII. TREATMENT PLANNING IMPLICATIONS FROM CBCT

• Surgical curettage/enucleation remains the primary treatment
• Cortical perforation means risk of soft-tissue extension - wider surgical margins needed
• Intralesional corticosteroid injections (triamcinolone) - medical option for non-aggressive/smaller lesions
• Calcitonin nasal spray/SC - adjunct medical therapy
• Interferon-alpha - for aggressive recurrent cases
• Post-operative CBCT follow-up at 6 months and 1 year to detect recurrence
• Orthodontic/prosthetic rehabilitation planning for displaced/resorbed teeth

• Tahmasbi-Arashlow M et al. Cone-beam computed tomographic imaging of central giant cell granuloma: A comprehensive review. Imaging Sci Dent. 2022 Jun. [PMID: 35799967]
• Zengin U et al. Histopathological and radiographic characteristics of central giant cell granulomas: a retrospective study of 45 cases. BMC Oral Health. 2025. [PMID: 41331443]
• Robbins, Cotran & Kumar. Pathologic Basis of Disease, 10th ed. - Fibrous Proliferative Lesions
• K.J. Lee's Essential Otolaryngology - Central Giant Cell Granuloma section