Brown tumour of the maxilla and mandible: a rare complication of tertiary hyperparathyroidism

Abstract

Hyperparathyroidism is nowadays diagnosed early and asymptomatically with the improvements in routine biochemical tests and radiological procedures. The late bony complications of the disease have therefore started to decline rapidly. Brown tumours are one of the bony complications of hyperparathyroidism. The mandible is the predominantly affected site in the maxillofacial area. Maxillary involvement is rare. Here, an extremely rare case of a 19-year-old male patient with brown tumours in his maxilla and mandible associated with tertiary hyperparathyroidism is presented. A thorough diagnostic work-up was carried out and treatment options for both hyperparathyroidism and brown tumours were discussed. The importance of different radiological evaluation methods and the consultation between the oral and maxillofacial surgeons, general practitioner dentists, endocrinologists and radiologists are emphasised.

Calcification of the external carotid arteries and their branches

“…3 The increasing prevalence globally of chronic renal disease 2 is likely to be accompanied by an increase in brown tumours overall and thereby an increase in the number of them affecting the jaws. Recently, Selvi et al 4 reported a case of brown tumours affecting the jaws in a patient exhibiting a similar history of CKD and its progression to renal failure and tertiary hyperparathyroidism, as in the present case. The brown tumour in the present case had regressed sufficiently for the patient to resume normal denture wear.…”

“…4 The differences were that not only did these arteries display no lumen but so did the ophthalmic artery, a branch of the internal carotid artery. Selvi et al's Figure 4 revealed that intravenous contrast had been used, thus accounting for the opacification of these arteries.…”

Diagnosis and Clinico-Radiological Presentation in an Aggressive Maxillary Brown Tumour

“…The disease is most frequent in postmenopausal women during the sixth decade of life, although it is seen in all age groups. Among patients with PHPT, the mandible, a cortical bone, is the most commonly affected site, and why a maxillary involvement is less common in the maxillofacial area [8].…”

“…Radiographically, Brown's tumour appears as a well defined unilocular or multilocular radiolucency and it is very similar to the other giant cell lesions like cherubism and aneurysmal bone cysts [10]. On clinical examination and on using only routine panoramic radiography, the lesions may resemble bone metastases of a carcinoma, multiple myeloma, Langerhan's cell histiocytosis, osteosarcoma, Paget's disease, osteomyelitis or osteonecrosis which is secondary to bisphosphonate therapy [8].…”

Hyperparathyroidism-jaw tumour syndrome detected by aggressive generalized osteitis fibrosa cystica

“…These lesions may produce awful pain and pathologic fractures (1)(2)(3). Association of primary hyperparathyroidism and ossifying fibroma of the jaw is seen in a rare hereditary syndrome referred as hyperparathyroidism-jaw tumour HPT-JT.…”