Large Brown Tumour of Mandible with Bleeding as Initial Presentation: A Case Report

Abstract

Brown Tumour or Osteitis fibrous cystic or Von-Recklinghausen disease of bone is a non-malignant condition due to abnormal metabolism of bones in hyperparathyroidism. Although pathognomonic of hyperparathyroidism, brown tumours are rare and only case reports are found in literature. We report a case of brown tumour of mandible with recurrent episodes of bleeding. A 46 year old male patient presented in emergency with bleeding from ulceroproliferative mass from left floor of mouth. After control of bleeding, radiological, laboratory and histopathological investigations were done that led to the diagnosis of brown tumour of mandible in the presence of parathyroid adenoma of left lower parathyroid gland. Left upper and lower parthyroidectomy was done with segmental resection of mandible with mass and titanium plating. Brown tumour of facial bones is a rare entity. Very rarely it can reach enormous sizes to cause bleeding. Although parathyroidectomy and correction of parathormone levels cause regression of small tumours, large brown tumours with complications should be managed with surgical resection and reconstruction.

Keywords: Brown tumour; Left; Mandible; Segmental.

Fig. 1

Photograph of patient showing left jaw swelling

Fig. 2

Intraoral photograph showing mass arising from floor of mouth with deviated tongue

Fig. 3

CECT image showing mass arising from left mandible

Fig. 4

CECT showing 56 x 26 x 62 mm mass with intraoral component and tongue deviation

Fig. 5

CECT showing left parathyroid adenoma

Fig. 6

3D acrylic model of mandible - anterior view

Fig. 7

3D acrylic model of mandible - superior view

Fig. 8

Intraoperative photograph showing defect post excision and titanium plate

Fig. 9

Photograph of pathological specimen