Pseudo neoplastic so-called bone brown tumors (BT), related to hyperparathyroidism (HPT), often localize in mandibula/maxilla. They are pathologically similar to central giant cell granulomas, have not clear pathogenesis and unpredictable prognosis. Many surgeons rely only on primary/secondary HPT definitive treatment to achieve regression of BT, other use corticosteroids or surgical procedures (curettage, excision). We present 3 different well illustrated cases, which demonstrate various scenario for BT after treatment of HPT.

Three young patients with PHPT-related BT were followed up: 30y man with MEN1 syndrome (PTH - 481 pg/ml; Ca++ - 1.54 mmol/l, right maxillary BT); 32y woman, multiglandular disease, non MEN, non PHPT-JT syndrome (PTH - 282 pg/ml, Ca++ - 1.69 mmol/l; mandibular BT); 45y woman, sporadic disease, single adenoma (PTH - 1687 pg/ml, Ca++ - 1.52 mmol/l; maxillary BT) were followed up during 3-5 y after successful surgical treatment of PHPT. In 34 y woman mandibular BT was excised due to wrong diagnosed osteosarcoma before the operation on parathyroids.

Stable maxillary BT with little shrinkage and improvement of local pain was detected in 2 years after parathyroid surgery in 30y man. No recurrence of BT but poor cosmetic results were observed in 32y woman. Almost complete resolution of left maxillary BT was revealed in 45y woman.

PHPT-related facial BT is a complex medical problem with unpredictable prognosis. Good chance for significant BT resolution could be awaited in any case during first years. Absence of symptomatic BT diminishing in first 1-2 years could argue into surgical interventions.