Atypical fibro-osseous lesion of maxilla: possibility of brown tumour or hyperparathyroidism

The non-neoplastic fibro-osseous lesions of the facial skeleton are rare and are usually considered to be fibrous dysplasia or ossifying fibroma. Brown tumour of the maxilla, on the other hand, is extremely rare with primary hyperparathyroidism (HPT) as its most common cause. This is a report of an atypical fibro-osseous lesion of the upper jaw (in her late thirties) that presented with painful smooth swelling around the premaxilla, adjoining hard palate and floor of the nose. With atypical radiology and variegated consistency, a complex diagnostic workup was undertaken, including FNAC, blood chemistry and a Sestamibi scan to conclude a diagnosis of primary HPT (parathyroid adenoma). A simple parathyroidectomy was performed which resulted in definite improvement in facial profile. Specific features are suggested for when to suspect an associated systemic disease, while a diagnostic approach to screen primary HPT in selected cases of fibro-osseous lesions of the facial skeleton is stressed.