In a recent report, de Lange et al2 performed daily administration of 200 IU calcitonin via nasal spray for a 15-month period in a boy with cherubism and observed considerable regression of the lesion after cessation of therapy. Similar to the manner of therapy used by de Lange et al,2 in the present case, calcitonin was administered via the selleck Tofacitinib nasal passage for duration of more than two years. The severity of cherubic lesions varies case to case, and its severity has been classified by previous authors (grades 1, 2 and 3, according to severity of lesions).10,19,20 The course of treatment may vary according to the size of the lesion. The present case might be considered as a grade 1 case of cherubism due to the fact that bilateral lesions occurred only in the posterior mandible, and the duration of the treatment was longer as well.

No side effects were observed during the treatment period. The dose, type, and administration method of calcitonin has been documented in many reports. 2,8,9,14 Since calcitonin was first used for CGCG, daily subcutaneous administration of human calcitonin has become the most common method of therapy. However, the use of salmon calcitonin has recently become more popular than using human calcitonin because of its increased potency and availability.21 The correct dose of calcitonin has been determined at 100 IU per day, which is based on the regimens previously used for Paget��s disease.22 On the other hand, the use of daily 200 IU salmon calcitonin via nasal spray for cherubism has been recently reported.

2 In the present case, 200 IU calcitonin was administered via nasal spray every-other-day to make an equivalent daily dose of 100 IU, because a 100 IU calcitonin nasal spray dosage was not available in the country. However, it is well known that daily subcutaneous administration of 100 IU calcitonin is considerably more effective than an every-other-day nasal dose of 200 IU. As a result, the two treatment regimens are not comparable due to the lower bio-availability of nasal spray. In general, subcutaneous application was preferred in order to achieve efficient absorption. Nevertheless, the absorbed amount of calcitonin might be unpredictable because of the condition of the nasal mucosa. However, systemic calcitonin dosage via nasal spray is considered the easiest method of management, especially in children.

To our knowledge, the present report is the second in which cherubic Brefeldin_A lesions were treated with systemic calcitonin administration via nasal spray for duration of more than one year. After approximately three years of treatment, calcitonin therapy was discontinued since radiographic regression of the lesions and growth of the patient had ended, and the patient was scheduled for follow-up. However, regression of the lesions through the natural course of the disease, due to the relatively older age of the patient, may have contributed to the successful outcome of the treatment.