Cherubism: best clinical practice

Maria E Papadaki, Steven A Lietman, Michael A Levine, Bjorn R Olsen, Leonard B Kaban, Ernst J Reichenberger, Maria E Papadaki, Steven A Lietman, Michael A Levine, Bjorn R Olsen, Leonard B Kaban, Ernst J Reichenberger

Abstract

Cherubism is a skeletal dysplasia characterized by bilateral and symmetric fibro-osseous lesions limited to the mandible and maxilla. In most patients, cherubism is due to dominant mutations in the SH3BP2 gene on chromosome 4p16.3. Affected children appear normal at birth. Swelling of the jaws usually appears between 2 and 7 years of age, after which, lesions proliferate and increase in size until puberty. The lesions subsequently begin to regress, fill with bone and remodel until age 30, when they are frequently not detectable.Fibro-osseous lesions, including those in cherubism have been classified as quiescent, non-aggressive and aggressive on the basis of clinical behavior and radiographic findings. Quiescent cherubic lesions are usually seen in older patients and do not demonstrate progressive growth. Non-aggressive lesions are most frequently present in teenagers. Lesions in the aggressive form of cherubism occur in young children and are large, rapidly growing and may cause tooth displacement, root resorption, thinning and perforation of cortical bone.Because cherubism is usually self-limiting, operative treatment may not be necessary. Longitudinal observation and follow-up is the initial management in most cases. Surgical intervention with curettage, contouring or resection may be indicated for functional or aesthetic reasons. Surgical procedures are usually performed when the disease becomes quiescent. Aggressive lesions that cause severe functional problems such as airway obstruction justify early surgical intervention.

Figures

Figure 1
Figure 1
Typical histopathology of Cherubism. A histological section from a cherubism lesion demonstrates the typical finding of multinucleated osteoclast-like giant cells (arrows) near bone and within soft fibrous stroma.
Figure 2
Figure 2
A. Photograph of a 10 year old girl with bilateral cheek and jaw swelling. Cherubism was confirmed with genetic testing that was positive for the SH3BP2 gene. The patient had genetic counseling and was followed longitudinally. B. Patient one year later with no progression of facial swelling. C. CT scan at initial presentation showed typical bilateral lytic lesions in the mandible that remained unchanged at follow ups.
Figure 3
Figure 3
Noonan/multiple giant cell lesion syndrome. A 20-year old woman with Noonan/multiple giant cell lesion syndrome with bilateral involvement of the mandible and the maxilla. A and B. Frontal and submental photographs reveal prominent maxillary and mandibular contours, slight frontal bossing and increased intercanthal distance, downslanting palpebral features, epicanthal folds and posteriorly angulated ears. Lesions were painless to palpation. C and D. Coronal and 3D CT scan at initial presentation demonstrate involvement of the maxilla, including the maxillary sinuses and the nasal-maxillary region and the mandible from the antegonial notch to antegonial notch. The lesions are expansile and mixed radiolucent - radiopaque with cortical thinning and expansion into the orbits bilaterally. Patient was positive for a Noonan syndrome mutation in SOS-1. She underwent a contour resection of the maxillary and the mandibular giant cell lesions in two sessions. Postoperatively, she was treated with 4 courses of zoledronic acid, given at 6-week-intervals. E and F. Post-treatment frontal and submental photographs.
Figure 4
Figure 4
Imaging studies of the patient in Figure 3 pre-treatment (A, C, E) and post-treatment (B, D, F). A and B. Panoramic radiographs. C and D. Lateral cephalograms. E and F. 3D CT scans. Pre- and post-treatment images show improvement of the giant cell lesions and the contours of the mandible.
Figure 5
Figure 5
Cherubism. A 5 year old boy who after a mild trauma underwent a dental evaluation. A. Examination revealed marked fullness of the cheeks, expansion of the malar eminences and the mandibular angle regions. B. Intraoral examination was significant for expansion of the mandibular alveolus in the permanent molar regions. C and D. Panoramic radiograph revealed bilateral radiolucent lesions in the mandible and maxilla (arrows). The lesions were displacing the permanent second molar tooth buds superior to the first molar teeth. E and F. Intraoral biopsy and removal of the displaced second molar tooth buds leaving the first molar tooth buds in place to erupt. Pathologic diagnosis was fibro-osseous lesion consistent with cherubism.

References

    1. Jones WA. Familial multilocular cystic disease of the jaws. American Journal of Cancer. 1933;17:946–950.
    1. Jones WA. Further observations regarding familal multilocular cystic disease of the jaws. British Journal of Radiology. 1938;11:227–241. doi: 10.1259/0007-1285-11-124-227.
    1. Jones WA, Gerrie J, Pritchard J. Cherubism--familial fibrous dysplasia of the jaws. Journal of Bone and Joint Surgery. British Volume. 1950;32-B(3):334–47.
    1. Arnott DG. Cherubism--an initial unilateral presentation. British Journal of Oral Surgery. 1978;16(1):38–46. doi: 10.1016/S0007-117X(78)80054-7.
    1. Seward GR, Hankey GT. Cherubism. Oral Surg Oral Med Oral Pathol. 1957;10(9):952–74. doi: 10.1016/S0030-4220(57)80047-4.
    1. Kalantar Motamedi MH. Treatment of cherubism with locally aggressive behavior presenting in adulthood: report of four cases and a proposed new grading system. Journal of Oral & Maxillofacial Surgery. 1998;56(11):1336–42. doi: 10.1016/S0278-2391(98)90618-8.
    1. Raposo-Amaral CE. et al.Two-stage surgical treatment of severe cherubism. Annals of Plastic Surgery. 2007;58(6):645–51. doi: 10.1097/01.sap.0000248141.36904.19.
    1. Anderson DE, McClendon JL. Cherubism - hereditary fibrous dysplasia of the jaws. I. Genetic considerations. Oral Surgery Oral Medicine Oral Pathology. 1962;15(Supplement):5–16.
    1. Reichenberger EJ. et al.The role of SH3BP2 in the pathophysiology of cherubism. Orphanet Journal of Rare Diseases. 2012;7(Suppl 1):S5. doi: 10.1186/1750-1172-7-S1-S5.
    1. Thompson N. Cherubism: familial fibrous dysplasia of the jaws. British Journal of Plastic Surgery. 1959;12:89–103.
    1. Kozakiewicz M, Perczynska-Partyka W, Kobos J. Cherubism--clinical picture and treatment. Oral Dis. 2001;7(2):123–30.
    1. Ozan B. et al.Postpubertal nonfamilial cherubism and teeth transposition. Journal of Craniofacial Surgery. 2010;21(5):1575–7. doi: 10.1097/SCS.0b013e3181ecc529.
    1. Wayman JB. Cherubism: a report on three cases. British Journal of Oral Surgery. 1978;16(1):47–56. doi: 10.1016/S0007-117X(78)80055-9.
    1. McClendon JL, Anderson DE, Cornelius EA. Cherubism - hereditary fobrous dysplasia of the jaws: II. Pathologic considerations. Oral Surgery Oral Medicine Oral Pathology. 1962;15(Supplement):17–38.
    1. Stiller M. et al.Craniosynostosis in cherubism. Am J Med Genet. 2000;95(4):325–31. doi: 10.1002/1096-8628(20001211)95:4<325::AID-AJMG6>;2-R.
    1. Petschler M. et al.[Clinical and molecular genetic observations on families with cherubism over three generations] Mund Kiefer Gesichtschir. 2003;7(2):83–7. doi: 10.1007/s10006-002-0444-x.
    1. Timoşca GC. et al.Aggressive form of cherubism: report of a case. Journal of Oral & Maxillofacial Surgery. 2000;58(3):336–44. doi: 10.1016/S0278-2391(00)90069-7.
    1. Colombo F. et al.Orbital involvement in cherubism. Ophthalmology. 2001;108(10):1884–8. doi: 10.1016/S0161-6420(01)00757-6.
    1. Font RL. et al.Giant cell reparative granuloma of the orbit associated with cherubism. Ophthalmology. 2003;110(9):1846–9. doi: 10.1016/S0161-6420(03)00577-3.
    1. Ahmadi AJ, Pirinjian GE, Sires BS. Optic neuropathy and macular chorioretinal folds caused by orbital cherubism. Archives of Ophthalmology. 2003;121(4):570–3. doi: 10.1001/archopht.121.4.570.
    1. Ladhani S, Sundaram P, Joshi JM. Sleep disordered breathing in an adult with cherubism. Thorax. 2003;58(6):552. doi: 10.1136/thorax.58.6.552.
    1. Battaglia A, Merati A, Magit A. Cherubism and upper airway obstruction. Otolaryngology - Head & Neck Surgery. 2000;122(4):573–4. doi: 10.1016/S0194-5998(00)70104-5.
    1. Silva EC. et extreme case of cherubism. Br J Oral Maxillofac Surg. 2002;40(1):45–8. doi: 10.1054/bjom.2001.0654.
    1. Faircloth WJ Jr., Edwards RC, Farhood VW. Cherubism involving a mother and daughter: case reports and review of the literature. J Oral Maxillofac Surg. 1991;49(5):535–42. doi: 10.1016/0278-2391(91)90185-O.
    1. Pontes FS. et al.Aggressive case of cherubism: 17-year follow-up. Int J Pediatr Otorhinolaryngol. 2007;71(5):831–5. doi: 10.1016/j.ijporl.2007.01.017.
    1. Ireland AJ, Eveson JW. Cherubism: a report of a case with an unusual post-extraction complication. British Dental Journal. 1988;164(4):116–7. doi: 10.1038/sj.bdj.4806369.
    1. Von Wowern N. Cherubism: a 36-year long-term follow-up of 2 generations in different families and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(6):765–72. doi: 10.1067/moe.2000.108438.
    1. Ueki Y. et al.Increased myeloid cell responses to M-CSF and RANKL cause bone loss and inflammation in SH3BP2 "cherubism" mice. Cell. 2007;128(1):71–83. doi: 10.1016/j.cell.2006.10.047.
    1. Ferguson PJ, El-Shanti HI. Autoinflammatory bone disorders. Curr Opin Rheumatol. 2007;19(5):492–8. doi: 10.1097/BOR.0b013e32825f5492.
    1. de la Fuente MA. et al.3BP2 deficiency impairs the response of B cells, but not T cells, to antigen receptor ligation. Mol Cell Biol. 2006;26(14):5214–25. doi: 10.1128/MCB.00087-06.
    1. Chen G. et al.The 3BP2 adapter protein is required for optimal B-cell activation and thymus-independent type 2 humoral response. Mol Cell Biol. 2007;27(8):3109–22. doi: 10.1128/MCB.01014-06.
    1. Foucault I. et al.The adaptor protein 3BP2 associates with VAV guanine nucleotide exchange factors to regulate NFAT activation by the B-cell antigen receptor. Blood. 2005;105(3):1106–13.
    1. Foucault I. et al.The chaperone protein 14-3-3 interacts with 3BP2/SH3BP2 and regulates its adapter function. J Biol Chem. 2003;278(9):7146–53. doi: 10.1074/jbc.M209509200.
    1. Jevremovic D. et al.Regulation of NK cell-mediated cytotoxicity by the adaptor protein 3BP2. J Immunol. 2001;166(12):7219–28.
    1. Maeno K. et al.Adaptor protein 3BP2 is a potential ligand of Src homology 2 and 3 domains of Lyn protein-tyrosine kinase. J Biol Chem. 2003;278(27):24912–20. doi: 10.1074/jbc.M301201200.
    1. Lietman SA. et al.Identification of a novel mutation of SH3BP2 in cherubism and demonstration that SH3BP2 mutations lead to increased NFAT activation. Hum Mutat. 2006;27(7):717–8.
    1. Southgate J. et al.Study of the cell biology and biochemistry of cherubism. Journal of Clinical Pathology. 1998;51(11):831–7. doi: 10.1136/jcp.51.11.831.
    1. Ozkan Y. et al.Clinical and radiological evaluation of cherubism: a sporadic case report and review of the literature. Int J Pediatr Otorhinolaryngol. 2003;67(9):1005–12. doi: 10.1016/S0165-5876(03)00179-4.
    1. Shah N, Handa KK, Sharma MC. Malignant mesenchymal tumor arising from cherubism: a case report. Journal of Oral & Maxillofacial Surgery. 2004;62(6):744–9. doi: 10.1016/j.joms.2003.12.015.
    1. Roginsky VV. et al.Familial cherubism: the experience of the Moscow Central Institute for Stomatology and Maxillo-Facial Surgery. International Journal of Oral & Maxillofacial Surgery. 2009;38(3):218–23. doi: 10.1016/j.ijom.2008.10.010.
    1. Meng XM, Yu SF, Yu GY. Clinicopathologic study of 24 cases of cherubism. International Journal of Oral & Maxillofacial Surgery. 2005;34(4):350–6. doi: 10.1016/j.ijom.2004.09.006.
    1. Carpten JD. et al.HRPT2, encoding parafibromin, is mutated in hyperparathyroidism-jaw tumor syndrome. Nat Genet. 2002;32(4):676–80. doi: 10.1038/ng1048.
    1. Yart A. et al.The HRPT2 tumor suppressor gene product parafibromin associates with human PAF1 and RNA polymerase II. Mol Cell Biol. 2005;25(12):5052–60. doi: 10.1128/MCB.25.12.5052-5060.2005.
    1. Woodard GE. et al.Parafibromin, product of the hyperparathyroidism-jaw tumor syndrome gene HRPT2, regulates cyclin D1/PRAD1 expression. Oncogene. 2005;24(7):1272–6. doi: 10.1038/sj.onc.1208274.
    1. Wang C. et al.Expression of c-Src and comparison of cytologic features in cherubism, central giant cell granuloma and giant cell tumors. Oncology Reports. 2006;15(3):589–94.
    1. Chomette G. et al.Cherubism. Histo-enzymological and ultrastructural study. International Journal of Oral & Maxillofacial Surgery. 1988;17(4):219–23. doi: 10.1016/S0901-5027(88)80043-2.
    1. Peñarrocha M. et al.Cherubism: a clinical, radiographic, and histopathologic comparison of 7 cases. Journal of Oral & Maxillofacial Surgery. 2006;64(6):924–30. doi: 10.1016/j.joms.2006.02.003.
    1. Jing X, Pu RT. Fine-needle aspiration cytological features of Cherubism. Diagnostic Cytopathology. 2008;36(3):188–9. doi: 10.1002/dc.20791.
    1. Gupta N. et al.Fine needle aspiration cytologic features of Cherubism: a case report. Acta Cytologica. 2010;54(4):595–7.
    1. Carroll AL, Sullivan TJ. Orbital involvement in cherubism. Clin Experiment Ophthalmol. 2001;29(1):38–40. doi: 10.1046/j.1442-9071.2001.00363.x.
    1. Gomes MF. et al.Aggressive behaviour of cherubism in a teenager: 4-years of clinical follow-up associated with radiographic and histological features. Dentomaxillofac Radiol. 2005;34(5):313–8. doi: 10.1259/dmfr/32866350.
    1. Wang CN. et al.The aggressive form of cherubism: report of two cases in unrelated families. British Journal of Oral & Maxillofacial Surgery. 2006;44(4):322–4. doi: 10.1016/j.bjoms.2005.10.003.
    1. Lannon DA, Earley MJ. Cherubism and its charlatans. Br J Plast Surg. 2001;54(8):708–11. doi: 10.1054/bjps.2001.3701.
    1. Ueki Y. et al.Mutations in the gene encoding c-Abl-binding protein SH3BP2 cause cherubism. Nat Genet. 2001;28(2):125–6. doi: 10.1038/88832.
    1. Zenn MR, Zuniga J. Treatment of fibrous dysplasia of the mandible with radical excision and immediate reconstruction: case report. Journal of Craniofacial Surgery. 2001;12(3):259–63. doi: 10.1097/00001665-200105000-00012.
    1. Lee SM, Cooper JC. Noonan syndrome with giant cell lesions. International Journal of Paediatric Dentistry. 2005;15(2):140–5. doi: 10.1111/j.1365-263X.2005.00604.x.
    1. Jafarov T, Ferimazova N, Reichenberger E. Noonan-like syndrome mutations in PTPN11 in patients diagnosed with cherubism. Clin Genet. 2005;68(2):190–1.
    1. Tartaglia M, Zampino G, Gelb BD. Noonan syndrome: clinical aspects and molecular pathogenesis. Mol Syndromol. 2010;1(1):2–26. doi: 10.1159/000276766.
    1. Noonan J, Ehmke D. Associated noncardiac malformations in children with congenital heart disease. J Pediatr. 1963;63:468–470.
    1. Chuong R. et al.Central giant cell lesions of the jaws: a clinicopathologic study. Journal of Oral & Maxillofacial Surgery. 1986;44(9):708–13. doi: 10.1016/0278-2391(86)90040-6.
    1. Dunlap C. et al.The Noonan syndrome/cherubism association. Oral Surgery, Oral Medicine, Oral Pathology. 1989;67(6):698–705. doi: 10.1016/0030-4220(89)90012-1.
    1. Cohen MM Jr., Gorlin RJ. Noonan-like/multiple giant cell lesion syndrome. Am J Med Genet. 1991;40(2):159–66. doi: 10.1002/ajmg.1320400208.
    1. Levine B, Skope L, Parker R. Cherubism in a patient with Noonan syndrome: report of a case. Journal of Oral & Maxillofacial Surgery. 1991;49(9):1014–8. doi: 10.1016/0278-2391(91)90069-X.
    1. Betts NJ. et al.Multiple central giant cell lesions with a Noonan-like phenotype. Oral Surgery, Oral Medicine, Oral Pathology. 1993;76(5):601–7. doi: 10.1016/0030-4220(93)90069-G.
    1. Addante RR, Breen GH. Cherubism in a patient with Noonan's syndrome. Journal of Oral & Maxillofacial Surgery. 1996;54(2):210–3. doi: 10.1016/S0278-2391(96)90449-8.
    1. Lee JS. et al.Phenotypic and genotypic characterisation of Noonan-like/multiple giant cell lesion syndrome. J Med Genet. 2005;42(2):e11. doi: 10.1136/jmg.2004.024091.
    1. Beneteau C. et al.SOS1 and PTPN11 mutations in five cases of Noonan syndrome with multiple giant cell lesions. Eur J Hum Genet. 2009;17(10):1216–21. doi: 10.1038/ejhg.2009.44.
    1. van Capelle CI. et al.Neurofibromatosis presenting with a cherubism phenotype. European Journal of Pediatrics. 2007;166(9):905–9. doi: 10.1007/s00431-006-0334-6.
    1. Edwards PC. et al.Bilateral central giant cell granulomas of the mandible in an 8-year-old girl with Noonan syndrome (Noonan-like/multiple giant cell lesion syndrome) Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics. 2005;99(3):334–40. doi: 10.1016/j.tripleo.2004.08.021.
    1. Quan F. et al.Spontaneous deletion in the FMR1 gene in a patient with fragile X syndrome and cherubism. Human Molecular Genetics. 1995;4(9):1681–4. doi: 10.1093/hmg/4.9.1681.
    1. Yalcin S. et al.Gingival fibromatosis combined with cherubism and psychomotor retardation: a rare syndrome. Journal of Periodontology. 1999;70(2):201–4. doi: 10.1902/jop.1999.70.2.201.
    1. Ruggieri M. et al.Unusual form of recurrent giant cell granuloma of the mandible and lower extremities in a patient with neurofibromatosis type 1. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics. 1999;87(1):67–72. doi: 10.1016/S1079-2104(99)70297-0.
    1. Pina-Neto JM. et al.Cherubism, gingival fibromatosis, epilepsy, and mental deficiency (Ramon syndrome) with juvenile rheumatoid arthritis. American Journal of Medical Genetics. 1986;25(3):433–41. doi: 10.1002/ajmg.1320250305.
    1. Suhanya J. et al.Cherubism combined with epilepsy, mental retardation and gingival fibromatosis (Ramon syndrome): a case report. Head Neck Pathol. 2010;4(2):126–31. doi: 10.1007/s12105-009-0155-9.
    1. Campanacci M, Laus M, Boriani S. Multiple non-ossifying fibromata with extraskeletal anomalies: a new syndrome? J Bone Joint Surg Br. 1983;65(5):627–32.
    1. Mankin HJ. et al.Non-ossifying fibroma, fibrous cortical defect and Jaffe-Campanacci syndrome: a biologic and clinical review. Chirurgia Degli Organi di Movimento. 2009;93(1):1–7.
    1. Hau MA. et al.Jaffe-Campanacci syndrome. A case report and review of the literature. J Bone Joint Surg Am. 2002;84-A(4):634–8.
    1. Tiziani V. et al.The gene for cherubism maps to chromosome 4p16. Am J Hum Genet. 1999;65(1):158–66. doi: 10.1086/302456.
    1. Mangion J. et al.The gene for cherubism maps to chromosome 4p16.3. American Journal of Human Genetics. 1999;65(1):151–7. doi: 10.1086/302454.
    1. Preda L. et al.Identical Mutation in SH3BP2 Gene Causes Clinical Phenotypes with Different Severity in Mother and Daughter - Case Report. Mol Syndromol. 2010;1(2):87–90. doi: 10.1159/000314268.
    1. Troulis MJ, Williams WB, Kaban LB. Staged protocol for resection, skeletal reconstruction, and oral rehabilitation of children with jaw tumors. Journal of Oral & Maxillofacial Surgery. 2004;62(3):335–43. doi: 10.1016/j.joms.2003.07.006.
    1. Katz JO, Dunlap CL, Ennis RL. Cherubism: report of a case showing regression without treatment. Journal of Oral & Maxillofacial Surgery. 1992;50(3):301–3. doi: 10.1016/0278-2391(92)90333-U.
    1. Papadaki ME, Troulis MJ, Kaban LB. Advances in diagnosis and management of fibro-osseous lesions. Oral Maxillofac Surg Clin North Am. 2005;17(4):415–34. doi: 10.1016/j.coms.2005.06.004.
    1. Koury ME, Stella JP, Epker BN. Vascular transformation in cherubism. Oral Surgery, Oral Medicine, Oral Pathology. 1993;76(1):20–7. doi: 10.1016/0030-4220(93)90287-E.
    1. Kuepper RC, Harrigan WF. Treatment of mandibular cherubism. Journal of Oral Surgery. 1978;36(8):638–41.
    1. Dukart RC. et al.Cherubism: report of case. Journal of Oral Surgery. 1974;32(10):782–5.
    1. Harris M. Central giant cell granulomas of the jaws regress with calcitonin therapy. British Journal of Oral & Maxillofacial Surgery. 1993;31(2):89–94. doi: 10.1016/0266-4356(93)90168-V.
    1. de Lange J. et al.A new mutation in the SH3BP2 gene showing reduced penetrance in a family affected with cherubism. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics. 2007;103(3):378–81. doi: 10.1016/j.tripleo.2006.05.012.
    1. Kaban LB, Dodson TB. Management of giant cell lesions. International Journal of Oral & Maxillofacial Surgery. 2006;35(11):1074–5. doi: 10.1016/j.ijom.2006.08.010. author reply 1076.
    1. Pogrel MA. Calcitonin therapy for central giant cell granuloma. Journal of Oral & Maxillofacial Surgery. 2003;61(6):649–53. doi: 10.1053/joms.2003.50129. discussion 53-4.
    1. Kaban LB. et al.Antiangiogenic therapy of a recurrent giant cell tumor of the mandible with interferon alfa-2a. Pediatrics. 1999;103(6 Pt 1):1145–9.
    1. Silva EC, Silva GCC, Vieira TC. Cherubism: Clinicoradiographic features, treatment, and long-term follow-up of 8 cases. Journal of Oral and Maxillofacial Surgery. 2007;65(3):517–522. doi: 10.1016/j.joms.2006.05.061.
    1. Lin J. et al.TNFalpha blockade in human diseases: an overview of efficacy and safety. Clinical Immunology. 2008;126(1):13–30. doi: 10.1016/j.clim.2007.08.012.
    1. Wong M. et al.TNFalpha blockade in human diseases: mechanisms and future directions. Clinical Immunology. 2008;126(2):121–36. doi: 10.1016/j.clim.2007.08.013.
    1. Pagnini I. et al.Ineffectiveness of tumor necrosis factor-alpha inhibition in association with bisphosphonates for the treatment of cherubism. Clinical and Experimental Rheumatology. 2011;29(1):147.
    1. Aliprantis AO. et al.NFATc1 in mice represses osteoprotegerin during osteoclastogenesis and dissociates systemic osteopenia from inflammation in cherubism. J Clin Invest. 2008;118(11):3775–89. doi: 10.1172/JCI35711.
    1. Ueki Y, Mukai T, Yoshitaka T. Mechanism of inflammation in cherubism. J Bone Miner Res. 2010;25(Suppl 1) Available at [ ]. Accessed [12-24-2010]

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