The patient was known to have chronic renal failure on hemodialysis. He had a history of progressive facial swelling with current right hard palatal hard swelling.

Uremic leontiasis ossea is a rare condition that occurs in patients with renal failure on hemodialysis with secondary hyperparathyroidism. It is characterized by swelling of the jaws, widening of the nares, flattened nasal bridge, and increased interdental spacing.

Radiographic features include:

• radiological criteria of renal osteodystrophy and secondary hyperparathyroidism
  • osteomalacia
  • skull thickening with salt and pepper appearance
  • diffuse maxillary and mandibular expansion with:
    • characteristic intramedullary serpiginous tunnels (feline stripes), or
    • zonal pattern which is characterized by alternating hypoattenuation and hyperattenuation rings caused by osteoclastic activity (lytic lesions) and osteoblastic activity (sclerosis) respectively

Differential diagnoses for this craniofacial appearance include fibrous dysplasia and Paget disease.