Evidence Based Solving Approach in Diagnosis of Primary Hyperparathyroidism with Oral Manifestations: Report of Three Unusual Cases
A 40-year-old female patient presented with swelling in the right maxillary region since 6 months with history of swelling in the same region 5 years back and thereafter swelling was excised. A small sized swelling recurred in the same region which gradually increased to the present size. Patient also gave the history of 5-6 kg weight loss in the past few months and felt anorexic and depressed.\nExtraoral examination revealed a firm, nontender round swelling, 6 cm in diameter in right maxillary region which extended anteroposteriorly from ala of nose to 2 cm medial to tragus of ear and superoinferiorly 2 cm below infraorbital margin to 1 cm below corner of the mouth.\nIntraoral examination revealed a firm, nontender, nonpulsatile reddish brown growth of size 5 × 5 cm extending buccally and palatally i.r.t 12-18 region. Displacement and mobility of 13,14, and 15 pus discharge with 12, 13, and 14 was noticed [; inset].\nIOPA radiograph revealed loss of lamina dura and cyst-like lesions i.r.t 45, 46, 47. Orhtopantomogram (OPG) revealed a soft tissue mass causing resorption of right maxillary alveolar region with displacement of regional teeth. Multiple cyst-like radiolucent areas in right side of body of the mandible and thinning of inferior border of mandible was observed. Generalized loss of lamina dura was also observed []. CT scan was also carried out which revealed tumor causing destruction of the alveolar bone in right maxilla and lytic lesion involving the left body of mandible [].