Secondary hyperparathyroidism causing increased jaw bone density and mandibular pain: A case report

Publication date: Available online 7 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Thomas Aerden, Koenraad Grisar, Margaux Nys, Constantinus Politis
We present the case of a 32-year-old male patient complaining of recurrent mandibular pain for 3.5 years. Panoramic radiography showed increased cortical density of the mandibular lower border. Scintigraphy and SPECT-CT revealed metabolic hyperactivity in that region without pathological lymph nodes. A bone biopsy of the mandibular lower border did not show inflammation or cytological atypia. Endocrinologic investigation confirmed secondary hyperparathyroidism due to hypovitaminosis D. Several weeks after starting therapy with oral vitamin D supplements, the symptoms completely disappeared. Increased cortical density is a rare manifestation of secondary hyperparathyroidism, which normally causes the lamina dura to vanish and a ground-glass appearance due to blurring of the trabecular bone pattern. As focal hyperostosis can have multiple benign or malignant causes, radiological examination of the jaw bones is indispensable for evaluating orofacial pain. Increased cortical density may be caused by metabolic diseases, requiring further investigations, including biopsy and blood analysis.



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