A 35-year-old man presents with gross loosening of both his lower left premolar teeth. The gingiva around them looks swollen and is purple–brown in colour. A radiograph shows irregular bone destruction to the apices. Incisional biopsy shows multinucleated osteoclast-like giant cells in a haemorrhagic fibrous stroma.
- Which investigations should now be performed?
The serum calcium level should be measured and radiographs reviewed to exclude hyperparathyroidism.
- If these prove negative, what treatment should be undertaken?
The lesion should be treated by local removal with curettage.
- Which other lesions in the jaws contain multinucleate giant cells of this type?
Osteoclast-like giant cells are found in
- giant-cell granuloma
- brown tumour of hyperparathyroidism
- Pagetʼs disease of bone
- aneurysmal bone cyst
- some fibro-osseous lesions, particularly cherubism.