Paget’s Disease of Maxilla with Paranasal Sinuses: A Case Report

Abstract

Paget’s disease of bone is a chronic skeletal disorder affecting predominantly elderly individuals. The pelvic girdle is the most common site to be affected; however, other sites such as long bones, spine, and skull are also frequently affected. The diagnosis of Paget’s disease is made through careful radiographic, biochemical and histopathological analysis. Although involvement of the maxilla is common, the involvement of the paranasal sinuses is comparatively rare. Radiographic presentation of skull lesions ranges from osteolysis to cortical thickening, with characteristic cotton-wool radiopacities and diploe thickening. A rise in serum alkaline phosphatase without a significant elevation in serum calcium and vitamin D levels is regarded as a typical biochemical sign of the disease. Paget’s disease of bone often presents asymptomatically in most cases until deformity becomes apparent. It is successfully treated with bisphosphonates, a group of anti-resorptive drugs, thereby reducing the associated morbidity and mortality. In the present case, Paget’s disease of the skull involving the maxilla with obliteration of the paranasal sinuses was diagnosed in an elderly female who presented with swelling in the posterior maxillary region and markedly elevated serum alkaline phosphatase and parathyroid hormone levels, while calcium and phosphate levels are typically within normal limits. Hereby, the authors present a case report of 64-year-old female patient with Paget’s disease of bone with craniofacial involvement resulting in cotton-wool radiopacities of the skull and elevated serum alkaline phosphatase. The patient was under pharmacological management with bisphosphonates and calcium supplements.

Keywords

• bisphosphonates
• cotton-wool radiopacity
• fibro-osseous lesion
• hypercementosis
• osteitis deformans
• serum alkaline phosphatase