A woman's upper jaw had swollen on both sides, and one of the lesions had broken through the bone's outer shell. Under the microscope, the tissue was crowded with giant cells, the kind pathologists see in several destructive jaw growths. Yet surgeons never operated on her face. The problem that mattered was a single overactive gland in her neck.
Her case is one of three described by oral surgeons at Mohammed V University in Rabat, Morocco, in a retrospective case series published online July 29 in the International Journal of Surgery Case Reports and included in the journal's September issue. All three women, ages 22 to 60, were treated between 2022 and 2023 for painless, expanding jaw lesions that turned out to be brown tumors, a bone complication of long-term excess parathyroid hormone. In each case, the jaw swelling was the first sign of a hormone disorder no one had yet diagnosed.
A Hormone Reading Far Above the Normal Range
In the upper-jaw case, 3D dental imaging showed lesions on both sides of the maxilla. The right one was well defined. The left was larger, poorly defined, and had perforated the bone's outer layer. Because both sides were involved, the team suspected a body-wide cause rather than a tooth-related problem.
A neck ultrasound found a 54-by-13-millimeter nodule on a left parathyroid gland, consistent with an adenoma, a benign growth that overproduces hormone. Blood work backed that up. Her parathyroid hormone level was 2,062 pg/mL, more than 30 times the upper limit of a commonly used reference range. Her calcium was 13.3 mg/dL, well above normal, and her alkaline phosphatase, a marker of bone turnover, was also high.
The four parathyroid glands help keep blood calcium in balance. When one becomes overactive, the extra hormone drives bone-dissolving cells to release calcium from the skeleton. In some patients, that breakdown leaves cavities filled with fibrous tissue, giant cells, and deposits of old blood pigment, which give the lesions their brownish color and their name. Despite the label, brown tumors are not cancer. The Moroccan authors note that they typically affect the axial skeleton and that jaw involvement is uncommon.
Fixing the Neck First
Doctors first brought her calcium down with medical treatment. Surgeons then performed a focused parathyroidectomy, removing the diseased gland while measuring hormone levels during the operation to confirm they had taken out the right one. Her jaw was left alone.
Six months later, 3D scans showed the lesions had shrunk, and their edges were better defined. At 12 months, both upper-jaw tumors had markedly regressed, and her calcium, parathyroid hormone, and alkaline phosphatase were back to normal.
The second woman with primary hyperparathyroidism had a lower-jaw lesion and a parathyroid hormone level of 914.5 pg/mL. She also had parathyroid surgery without jaw surgery, and her lesion was significantly smaller six months later. The third patient had secondary hyperparathyroidism tied to kidney failure and was on dialysis, and her case was managed conservatively. None of the three needed surgery to cut out jaw bone. The authors say that reflects a broader principle: correcting the hormone problem often lets the lesions regress on their own.
That approach has support beyond this series. A 2023 Tunisian study of 16 patients with jaw brown tumors called parathyroidectomy the gold-standard treatment for the primary form of the disease.
Easy to Mistake for Something Else
The catch is that brown tumors can look like other giant cell-rich jaw lesions on scans and under the microscope. The Moroccan team recommends checking blood calcium and parathyroid hormone whenever jaw lesions appear in several spots, show up on both sides, or behave unusually aggressively, and doing so before planning any local surgery.
A February 2026 case from Rawalpindi, Pakistan, shows why. Doctors found a 5.4-by-4.6-centimeter lesion in a patient's right upper jaw. Blood tests and nuclear imaging pointed to a parathyroid adenoma, and after the gland was removed, the facial swelling had mostly resolved by the two-month follow-up. The authors wrote that isolated facial swelling may be the first sign of primary hyperparathyroidism.
A Common Disorder with a Rare Complication
Primary hyperparathyroidism itself is not rare. The National Institute of Diabetes and Digestive and Kidney Diseases has estimated that about 100,000 people in the United States develop it each year. It is diagnosed most often between ages 50 and 60, and women are affected about three times as often as men.
Brown tumors are far less common. They have been reported in about 4.5% of people with primary hyperparathyroidism and 1.5% to 1.7% of those with the secondary form. Because routine blood tests now often catch high calcium early, many people are diagnosed before bone damage develops.
The Moroccan series has clear limits. It includes only three patients from a single center, relies on a look back at records, and cannot predict how every jaw lesion will respond. Not every jaw growth tied to parathyroid disease behaves the same way, either. In hyperparathyroidism-jaw tumor syndrome, an inherited condition caused by changes in the CDC73 gene, the jaw growths are ossifying fibromas, a different kind of lesion.
The practical takeaway is simple. An unexplained swelling of the jaw or face deserves prompt evaluation by a dentist, oral surgeon, or physician, and for giant cell-rich jaw lesions, a basic calcium and hormone check can change the entire treatment plan.
Key Questions Answered
What is a brown tumor?
It is a bone lesion caused by long-term excess parathyroid hormone. It is not cancer, although it can look aggressive on imaging and under the microscope.
Why did a neck gland affect the jaw?
An overactive parathyroid gland released too much hormone, which speeds up bone breakdown. In these three women, the damage first became noticeable in the jaw.
Did the patients need jaw surgery?
No. The two women with primary hyperparathyroidism had parathyroid surgery, and their jaw lesions regressed. The third patient's case was managed conservatively.
How common are brown tumors?
They have been reported in about 4.5% of people with primary hyperparathyroidism and 1.5% to 1.7% of those with the secondary form. Jaw involvement is uncommon.
What symptoms can hyperparathyroidism cause?
Many people have no symptoms and are diagnosed after a routine blood test shows high calcium. Others develop kidney stones, bone pain, or digestive complaints.
What remains uncertain?
The Moroccan findings come from three patients at one center, so they cannot predict how every jaw lesion will respond to treatment.
Published by Medicaldaily.com
