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Spontaneous And Excellent Healing Of Bilateral Brown Tumors In Mandible After Endocrinal Therapy And Subtotal Parathyroidectomy: Case Report With 4-year Follow-up

Yucesoy, T. 2018Other/Unknown

Yucesoy, T., Kilic, E., Dogruel, F., Bayram, F., Alkan, A., Akcan, A. C., & Ozturk, F. (2018). Spontaneous and Excellent Healing of Bilateral Brown Tumors in Mandible after Endocrinal Therapy and Subtotal Parathyroidectomy: Case Report with 4-Year Follow-Up. Case reports in dentistry, 2018, 8070131. https://doi.org/10.1155/2018/8070131

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Abstract

Primary hyperparathyroidism is an endocrine disorder occurring due to increased secretion of parathormone resulting in a complex of clinical, anatomical, and biochemical alterations. On the other hand, excision of a parathyroid adenoma can normalize the metabolic status. A 24-year-old man was referred to the hospital with bilateral swelling and spontaneous gingival bleeding from posterior of the mandible also with radiolucent well-demarcated lesions bilaterally in the mandibular third molar regions. After consultations, the patient was hospitalized in the endocrinology department where further tests were performed due to highly increased PTH level as 714 pg/ml. Bilateral brown tumors started to regress spontaneously, and no additional surgery was required after subtotal parathyroidectomy was performed. The presented case is the first patient whose bilateral brown tumors in the jaws spontaneously and totally healed after subtotal parathyroidectomy and endocrinal therapy who was strictly followed up for 4 years even though the lesions were associated with impacted third molars.

Case Details

Disease Location

Mandible

Personal Characteristics

24-year-old man. Familiar history: the father had a serious endocrine disease 30 years ago, and received endocrine treatment because of a problem in his parathyroid glands.

Clinical Characteristics

Bilateral swelling and spontaneous gingival bleeding from the posterior of the mandible. Intraoral examination revealed pericoronitis and spontaneous bleeding from the periodontal pocket of the right mandibular second molar and swelling in the bilateral retromolar regions bilateral not well-demarcated radiolucent lesions in the posterior regions of the mandible, measuring 4×3×3cm on the right and 2.5×1.5×1.5cm on the left, were observed in the radiographic examination, because of his family’s history of endocrine disorders and the panoramic radiography, a brown tumour was suspected. Biochemical tests demonstrated extremely high pth level and high level of serum ca. Subtotal parathyroidectomy was performed and parathyroid hyperplasia was diagnosed pathologically.

Remission Characteristics

In the radiographic examination, partial calcification of the mandibular lesions was observed after 6 months. Also, after intraoral examination, spontaneous periodontal healing was uneventful

Treatment & Mechanisms

Clinical Treatment

Subtotal parathyroidectomy