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Mandibular Brown Tumor of Secondary Hyperparathyroidism Requiring Extensive Resection: A Forgotten Entity in the Developed World?

Qaisi M, Loeb M, Montague L, Caloss R - Case Rep Med (2015)

Bottom Line: This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT.It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT.Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early.

View Article: PubMed Central - PubMed

Affiliation: Oral-Head & Neck Oncology/Microvascular Surgery, Department of Oral-Maxillofacial Surgery & Pathology and Department of Otolaryngology, Cancer Institute, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.

ABSTRACT
Brown tumor of hyperparathyroidism (BTHPT) is rare in the United States and not frequently seen in clinical practice. This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT. Conversely, BTHPT is more common in underdeveloped countries where fewer patients have access to health care and hyperparathyroidism (HPT) goes untreated. It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT. We present a case report of a patient in the United States with a large mandibular BTHPT requiring an extensive resection in the setting of secondary HPT. Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early.

No MeSH data available.


Related in: MedlinePlus

(a) Access to large brown tumor via lip split mandibulotomy approach. (b) Reconstruction bar placement.
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fig7: (a) Access to large brown tumor via lip split mandibulotomy approach. (b) Reconstruction bar placement.

Mentions: A discussion was held with the patient and treating nephrologist. Given the extent of the tumor and the uncontrolled underlying disease, it was decided that surgical intervention was the best option. Segmental resection with minimal margins was performed because marginal resection or enucleation procedures were deemed not feasible due to the limited amount of bone. This was done via a transcervical lip splitting approach due to limited access from the extensive size of the tumor (Figures 6–8 and supplemental video in Supplementary Material available online at http://dx.doi.org/10.1155/2015/567543). A microvascular free tissue transfer was not performed at that time because the treating nephrologist did not feel the patient could tolerate a lengthy surgery. Virtual surgical planning was utilized to help plan the mandibular resection as well as the reconstruction bar placement (Figure 9). Postoperatively, the patient's hospital course was uneventful. He was followed up by the inpatient nephrology team and continued to receive dialysis while he remained in the hospital.


Mandibular Brown Tumor of Secondary Hyperparathyroidism Requiring Extensive Resection: A Forgotten Entity in the Developed World?

Qaisi M, Loeb M, Montague L, Caloss R - Case Rep Med (2015)

(a) Access to large brown tumor via lip split mandibulotomy approach. (b) Reconstruction bar placement.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556817&req=5

fig7: (a) Access to large brown tumor via lip split mandibulotomy approach. (b) Reconstruction bar placement.
Mentions: A discussion was held with the patient and treating nephrologist. Given the extent of the tumor and the uncontrolled underlying disease, it was decided that surgical intervention was the best option. Segmental resection with minimal margins was performed because marginal resection or enucleation procedures were deemed not feasible due to the limited amount of bone. This was done via a transcervical lip splitting approach due to limited access from the extensive size of the tumor (Figures 6–8 and supplemental video in Supplementary Material available online at http://dx.doi.org/10.1155/2015/567543). A microvascular free tissue transfer was not performed at that time because the treating nephrologist did not feel the patient could tolerate a lengthy surgery. Virtual surgical planning was utilized to help plan the mandibular resection as well as the reconstruction bar placement (Figure 9). Postoperatively, the patient's hospital course was uneventful. He was followed up by the inpatient nephrology team and continued to receive dialysis while he remained in the hospital.

Bottom Line: This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT.It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT.Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early.

View Article: PubMed Central - PubMed

Affiliation: Oral-Head & Neck Oncology/Microvascular Surgery, Department of Oral-Maxillofacial Surgery & Pathology and Department of Otolaryngology, Cancer Institute, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.

ABSTRACT
Brown tumor of hyperparathyroidism (BTHPT) is rare in the United States and not frequently seen in clinical practice. This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT. Conversely, BTHPT is more common in underdeveloped countries where fewer patients have access to health care and hyperparathyroidism (HPT) goes untreated. It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT. We present a case report of a patient in the United States with a large mandibular BTHPT requiring an extensive resection in the setting of secondary HPT. Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early.

No MeSH data available.


Related in: MedlinePlus