Brown Tumours: A Case of a Non-Healing Tooth Socket

Introduction: Brown tumours are boney complications of hyperparathyroidism. They giant cell lesions that often appear as an expansile osteolytic lesion of the bone. We discuss the diagnosis and management of a brown tumour that presented as a non-healing extraction socket. Case Report: A 59 year old male presented with a one year history of a non-healing extraction socket on the lower left mandible following the removal of the LL6. The socket was not associated with any acute symptoms such as pain or swelling, but lack of mucosal closure persisted despite local measures with his general dental practitioner. The patient had a medical background of hypercholestrolaemia, hypertension, and anxiety. He previously had hyperparathyroidism as a result of a parathyroid adenoma, which was surgically removed 6 months after the dental extraction. Intra-oral examination revealed a suspicious-looking heterogenous lesion on the lower left alveolar ridge within the extraction socket. Radiographically there was a diffuse area of irregular radiolucency along the lower left mandible which had a moth eaten appearance in the absence of retained tooth fragments. An urgent incisional biopsy was undertaken which showed giant cells present. Bloods revealed mildly elevated calcium levels and low levels of phosphate. A diagnosis of Brown’s Tumour was made and the area was curetted and treated with Leukocyte-Platelet Rich Fibrin (L-PRF) and primary closure. Discussion: We discuss the possible differential diagnoses of non-healing tooth sockets together with the pathology of Giant Cell Lesions and their surgical management including the benefits of using L-PRF to improve healing. Conclusion: Brown tumours in the mandible can present as a non-healing extraction socket. Curettage and treatment with L-PRF is enables boney healing and is suitable management technique for this type of presentation.