Osteitis fibrosa (brown tumor) of the maxilla

Patients who present to the regional specialist with localized manifestations of systemic disease provide especially interesting diagnostic problems. We present a patient who was seen initially for facial swelling, thought to be caused by carcinoma of the antrum; however, tissue for biopsy was compatible with osteitis fibrosa, giant cell reparative granuloma, or giant cell tumor of bone, lesions which have identical histopathologic features. There were no other radiographic abnormalities, but the diagnosis of hyperparathyroidism was suggested by persistent hypercalcemia without other clinical states to explain the abnormality and was confirmed by parathyroid exploration which revealed a large adenoma. Prior to operation, causes of hypercalcemia, such as malignant disease, the milk‐alkali syndrome, hypervitaminosis D, and others were ruled out by clinical evaluation. When the Brown tumor of the maxilla failed to regress following treatment of the primary disease it was necessary to remove the mass surgically to relieve nasal obstruction and achieve a more acceptable facial appearance. Brown tumors are seen occasionally in the skull and facial bones, but occurrence in the maxilla appears to be quite rare. Only six cases of isolated presentation of this abnormality in the maxilla have been cited. In each case this was an oral rather than a superior maxillary manifestation of the disease, the mass presenting from the superior alveolus or the hard palate.