ESPE Abstracts (2019) 92 P3-310

Case Report: Primary Hyperparathyroidism Presenting as a Brown Tumor of Mandible in an Adolescent Girl - An Unusual Presentation with Challenges and Outcome

Jaida Manzoor1, Saeed Ahmed1, Nabila Talat1, Abid Ali Qureshi1, Aisha Tahir2

1The Children's hospital & Institute of Child Health, Lahore, Pakistan. 2University of Health Sciences, Lahore, Pakistan

Brown tumor is a rare non-neoplastic focal giant cell lesion resulting due to increase osteolytic activity by excess of parathormone in cortical bone which is replaced by fibrovascular tissue, giant cells with hemorrhages and hemosiderin. It is a rare late stage bone sequelae of long standing hyperparathyroidism. Parathyroid adenoma is the commonest cause of primary hyperparathyroidism.

We present a referred case of 15-year-old girl with highly aggressive mandibular mass creating swallowing difficulties, oral bleeding episodes, and anterior mandibular erosion with dislodgement of teeth. The thorough clinical, biochemical, histopathology and comprehensive radiological assessment reveal parathyroid adenoma leading to a hyperparathyroid state leading to brown tumor. A rare presentation of long standing hyperparathyroidism was a challenge to treat with favorable outcome in poor resources. The main stay of treatment was removal of left upper parathyroid adenoma resulting in reversal of metabolic de-arrangements but subsequent follow-up showed incomplete regression of tumor. Complete surgical excision of large disfiguring mandible residual and symptomatic mass was done successfully with osteotomy. No evidence of recurrence was observed in one-year follow-up. Thereafter reconstructive surgery of anterior mandibular bone was performed using alloplastic devices and bone grafts from cadaveric source and synthetic bone fragments. Alloplastic surgical membrane covered the whole augmented bone. After few months of optimized healing, restoration of incisors and canines teeth was done initially by placing artificial denture followed by permanent tooth implantation.

Such complications are rarely seen in presence of good medical standards and provision of advanced analytic facilities but still cases are encountered in underdeveloped countries with poor health facilities. The desirable aesthetic outcomes can only be produced with great expertise and can be achieved with biomaterial implants to replace, reconstruct and/or augment the tissue.

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