A 40-year-old man presented with a 5-year history of progressive facial changes and difficulty chewing. He had a history of chronic kidney disease and became dialysis dependent at the age of 17. On examination, protruding upper jaw with malocclusion was observed. His intact parathyroid hormone level exceeded 2500 pg/mL (reference range: 15.6–68.3). CT of the face showed cranial bone thickening, and overgrowth of the maxilla and mandible (figure 1A,B). Salt and pepper appearance was seen in the calvaria (figure 1B, arrow). These findings were consistent with uremic leontiasis ossea, a rare and severe form of renal osteodystrophy due to hyperparathyroidism.1
Leontiasis ossea—also known as lion face—results in not only disfigurement of the patient, but also the bony expansion may also compress the nearby facial structures, such as the nasal and oral cavity, leading to airway obstruction, dysarthria and dysphagia (figure 1C, arrow).<cross-ref type="bib"…