Aggressive Central Giant Cell Granuloma of the Maxilla Presenting as Extensive Hemimaxillary Expansion: A Case Report

Central giant cell granuloma (CGCG) is an uncommon benign intraosseous lesion of the jaws characterized by the proliferation of multinucleated giant cells within a fibrovascular stroma. Although most lesions present as slow-growing and asymptomatic, aggressive forms may cause significant bone destruction and involvement of adjacent anatomical structures. Maxillary localization is relatively rare and may present diagnostic and therapeutic challenges due to the proximity of the maxillary sinus, nasal cavity, and orbital floor. We report the case of a 20-year-old patient with no significant medical history who presented with a progressive bony expansion of the left hemimaxilla evolving over six months. Clinical examination revealed a hard, painless intraoral swelling extending from the vestibular and palatal aspects of teeth 22 to 27, with normal overlying mucosa and no regional lymphadenopathy. Panoramic radiography demonstrated a radiopaque osseous lesion involving the left maxilla. Cone-beam computed tomography (CBCT) revealed a large complex lesion occupying the entire left hemimaxilla with extension into the maxillary sinus, the lateral wall of the nasal cavity, and the orbital floor. Histopathological examination following incisional biopsy confirmed the diagnosis of central giant cell granuloma. The patient underwent left hemimaxillectomy under general anesthesia with complete en bloc resection of the lesion. Postoperative rehabilitation was achieved using a maxillofacial obturator prosthesis to restore oral-nasal separation and improve functional outcomes. Extensive maxillary CGCG remains a rare but potentially aggressive lesion requiring careful radiological assessment and histopathological confirmation. Radical surgical management combined with appropriate prosthetic rehabilitation can provide satisfactory functional and aesthetic outcomes while reducing the risk of recurrence.