A Comparison of Maxillofacial and Axial/Appendicular Giant Cell Lesions in Pediatric Patients: Management Strategies and Outcomes

Although giant cell lesions (GCLs) of the maxillofacial (MF) and axial/appendicular (AA) skeleton are managed as distinct entities, the comparative outcomes of these approaches remain uncertain. The pediatric population is particularly understudied, despite unique management considerations and the need to minimize surgical morbidity. This study compares characteristics and long-term outcomes of MF and AA GCL management in a pediatric and adolescent population. A retrospective cohort study of patients with histologically confirmed GCLs from 2002 to 2024 was conducted. MF lesions were designated aggressive or nonaggressive by Chuong and colleagues' criteria; AA lesions were graded I to III using Campanacci's system. Outcomes included tumor recurrence and long-term remission. Overall, 29 patients met inclusion criteria (16 MF, 13 AA). Mean follow-up was 4.0±3.1 years. MF lesions more frequently received adjuvant pharmacologic therapy (P<0.001), whereas surgical adjuvants were more common in AA lesions (P=0.025). Recurrence occurred 6.2% of MF and 23.1% of AA lesions (P=0.19). Remission was achieved in 100% of MF lesions and 76.9% of AA lesions (P=0.13). All 5 grade III AA lesions either recurred or failed to achieve remission. Overall, MF GCLs were more likely to receive APT, whereas AA GCLs exhibited higher recurrence and lower remission rates. These findings highlight the importance of early identification of grade III AA lesions, which may require increased surveillance and the consideration of pharmacologic adjuvants. Ultimately, a tailored, multidisciplinary approach and the use of conservative surgical approaches with adjuvant therapy may reduce morbidity and optimize long-term outcomes.