Maxillary mass: A rare presentation of primary hyperparathyroidism

A 40-year-old female presented with a right-sided facial swelling that had been gradually increasing in size over the last 6 months. She had a medical history of bilateral nephrolithiasis. Physical examination revealed a 5 cm × 5 cm hard swelling over the right malar region and an epulis over the right half of the upper jaw. The overlying teeth were loose. There was another 2 cm × 2 cm hard swelling over the right half of the mandible. Investigations revealed hypercalcemia, hypophosphatemia, and elevated intact parathyroid hormone levels. Radiograph of the skull revealed lytic lesions involving the right maxilla and mandible. Ultrasonography of the neck and 99m Tc-SESTAMIBI scan revealed a right inferior parathyroid adenoma. She was diagnosed as having primary hyperparathyroidism with maxillary and mandibular brown tumors. She underwent surgical excision of the parathyroid adenoma. Postoperatively hypercalcemia resolved; at 8 months, the maxillary mass had reduced in size. Even after 2 years of clinical follow, the maxillary brown tumor has not disappeared completely.