LES TUMEURS BRUNES : UN DIAGNOSTIC A EVOQUER EN PATHOLOGIE OSSEUSE MAXILLO-FACIALE

Abstract

Brown tumors are a rare non-neoplastic lesion of late onset, resulting from an abnormality of bone metabolism during hyperparathyroidism. Their localization in the facial skeleton is rare. The positive diagnosis is based on a beam of arguments and conditions the management; the treatment depends on the etiology. We report a unicentric retrospective descriptive study, including 4 patients, carried out in the department of oral and maxillofacial surgery of the Mohammed V armed forces hospital in Rabat, over a 15-year period, from January 2007 to January 2022. According to the inclusion criteria, 04 patients were recruited in our study, all female, aged between 19 and 41 years, with no family history. Mandibular location was found in one patient, maxillary location in two patients, and maxillomandibular location in one patient. Primary hyperparathyroidism on parathyroid adenoma was found in 2 cases, secondary hyperparathyroidism on chronic renal failure in 1 case and tertiary hyperparathyroidism in 1 case. The treatment of the tumor was surgical in 2 cases (one tumor removal and one conservative surgical management) and medical in 2 cases. Two patients beneted from a parathyroidectomy. A complete regression was observed in 75% of cases. This study shows the importance of evoking the diagnosis of a brown tumor in the facial skeleton when a patient presenting hyperparathyroidism with giant cells on histological examination shows the presence of bone call points, even if they are rare and/or late. Management is multidisciplinary. Surgical removal is indicated in case of failure of medical treatment, absence or delay of tumor regression after parathyroidectomy, and will depend on the volume of the localization and the impact of the tumor. It would therefore be judicious, in the case of a giant cell tumor of the facial skeleton, to establish algorithms allowing a rapid and precise diagnosis guaranteeing an adequate management.