Rabab Ahmad

Title: Denosumab as an alternative to surgical management for giant cell tumours of the mandible; A case report

Abstract:

Introduction/Aims: Giant Cell Tumours (GCT) are benign locally aggressive tumours arising in bone. The majority occur in the long bones with a small percentage of these lesions (<1%) occurring in the facial skeleton. Treatment of these tumours is challenging due to a propensity for recurrence and high morbidity associated with surgical removal. Denosumab is a RANKL inhibitor that has been used to manage GCT and avoid surgery with the majority of reported cases affecting the long bones. Denosumab has also been identified as a potential surgery sparing treatment for patients with GCT of the mandible where resection is not possible or will have considerable associated morbidity. This case report describes the use of Denosumab to successfully manage a large giant cell tumour of the mandible. 

Materials and Methods: Retrospective data collection via electronic notes system. 

Results/Statistics: A 25 year old male presented with facial asymmetry and a firm swelling in the left posterior mandible. Histology confirmed a diagnosis of GCT. Management using Denosumab rather than surgery was decided following multidisciplinary discussion. Six doses of subcutaneous Denosumab were administered over a four month period at weekly intervals for the first three doses, following by monthly intervals for the final three doses. Imaging 2 months after the final dose of Denosumab showed evidence of calcification of the GCT and histology at 6 months revealed bony healing with no residual features of GCT. 

Conclusions/Clinical Relevance: This case report suggests that management of GCT of the mandible with Denosumab is a potential alternative to surgical management of GCT.

Audience Take Away: 

• The audience should be aware of an alternative management approach for mandible GCTs
• The audience should understand the benefits of using Denosumab to treat GCTs of the mandible, compared with surgical management
• The audience should consider Denosumab as an alternative treatment option where appropriate, to reduce patient morbidity

Biography:

Dr Ahmad graduated in 2020 with a Bachelor of Dental Surgery from Aberdeen University, Scotland, following an undergraduate degree in Biomedical Sciences from Plymouth University (2015).  She then went on to work in general dental practice in London for a year, before undertaking two years in hospitals across London working within oral and maxillofacial surgery, paediatric dentistry, oral surgery and orthodontic departments. She currently works in oral and maxillofacial surgery at the Queen Elizabeth University Hospital, Glasgow.